Breast reconstruction using tissue from your tummy

The most common breast reconstruction surgery is using tissue from the tummy area (abdomen) along with its blood vessels. This is called a free DIEP flap (deep inferior epigastric perforator flap).

This is similar to the DIEP flap. It uses skin and fat from the lower tummy area only, without any muscle. But the surgeon uses a different blood vessel to create the new blood supply.

The surgeon uses a muscle, as well as fat and skin, from your tummy area to create a new breast shape. This is usually done as a free flap operation, but may be a pedicled flap. 

After removing the muscle, the surgeon may put a mesh in. This is to strengthen the tummy wall and stop a bulge or hernia developing.

Pedicled flaps are not often used. But they may be an option if you have already had surgery to the tummy area or if microvascular surgery is not suitable. The belly button is repositioned using tissue from your tummy. You will have a scar around the belly button.

• Breast reconstructions using tissue from the tummy are complex. The surgery can take longer than operations using tissue from the back.
• They have a slightly higher risk of complications than operations using tissue from the back.
• You will spend several days in hospital, and it takes several weeks to recover.
• You may have a patch of skin on your breast which is a different skin tone.
• You will have a scar across your tummy below your belly button. This will be from hip to hip. You will also have one around your belly button.
• You may have some loss of sensation (numbness) in the tummy area.
• Most operations using tissue from the tummy are successful. The failure rate is less than 3 in 100 (3%).

With any operation, there are risks, such as infection. There are also some specific risks with this type of reconstruction.

After wound drains are taken out, fluid sometimes builds up under the wound. This is called a seroma. It usually gets better within a few weeks. You may be asked to buy supportive underwear to wear for about 6 weeks after surgery. Wearing this will support your tummy and help reduce swelling and seromas.

If you have a TRAM flap, it uses one of the muscles from the front of the tummy. These muscles form the six-pack. They are important for lifting and physical work. They also work with the back muscles. If they are weakened, you may notice when you sit up from lying down.

You may find some sports and physical activities more difficult. A physiotherapist may give you exercises to strengthen your tummy.

A muscle-sparing TRAM flap (MS-TRAM flap) uses only part of the muscle. Because of this, it is less likely to cause muscle weakness than a standard TRAM flap operation.

DIEP and SIEA flaps do not use any muscle. This helps keep more strength in the tummy.

If a muscle is used, there is a higher risk of a bulge or hernia developing in the part of the tummy called the abdominal wall.

Sometimes the surgeon will use a mesh to strengthen the abdominal wall. This is to try to stop a bulge or hernia developing. The mesh may be permanent. Or it may be one that dissolves in time.

A DIEP or SIEA flap reduces the risk of a bulge or hernia because no muscle is used. But a bulge can develop after any type of flap surgery that uses tissue from the tummy.

If a hernia develops, it can usually be repaired with an operation.