TRAM - DIEP - SIEA

Some Advantages and Disadvantages

The muscle and fascia are harvested with the flap.  The pedicle leash tends to be more fixed to the flap.

Straight forward surgical dissection

Excellent aesthetic results

Weakening of the abdominal wall
 

Potential loss of abdominal strengtH

Greater potential for hernia formation

Loss of the rectus muscle

The muscle is not harvested with the flap.  Small perforators that traverse the muscle are harvested with the deep inferior epigastric artery and vein

Preservation of the rectus muscle

Preservation of the rectus sheath

Less post-operative pain

Potential quicker recovery

Must be performed by an experienced microsurgeon and microsurgical team.

Required opening of the rectus sheat and operating in and aroundt he rectus muscle.

There is potential for hernia formation.

The muscle and fascia are left behind as in the DIEP.  However, in contrast to the DIEP, no intramuscular or sub-fascial dissection needs to be performed to dissect the superficial vessels

Preservation of the rectus sheath with no violation of the rectus sheath

Preservation of the rectus muscle with no violation of the rectus muscle

Less post-operative pain

Potential speedier recovery

Shorter surgical procedure than the DIEP flap

Must be performed by an experienced microsurgeon and microsurgical team.

PATIENT SELECTION IN AUTOLOGOUS SOFT TISSUE BREAST RECONSTRUCTION

The unique circumstances of each specific patient help define the choice of a reconstruction method.  No single technique is applicable to all patients.  Consultation with an experienced microsurgeon is required to determine if a patient is a candidate for autologous reconstruction with a DIEP or SIEA flap.  Although technically more complex, the potential benefits DIEP and SIEA flaps can be significant.