Delayed Reconstruction DIEP/TRAM FLAP

I met with my PS a couple of weeks ago and he recommended what I think was a DIEP reconstruction. I am due to see him again in a weeks time to give my final decision. He gave me loads of reading material and website to look at.

A question I have though and thought someone on here may have experienced the same is the difference between a DIEP and a TRAM. Whilst I thought he described a DIEP I have now received a letter from him which he has copied to my GP and my BCN which states that he discussed a DIEP/Free TRAM flap reconstruction.

In my research it appears there is no such thing - its either a DIEP where no muscle is taken or its a TRAM where muscle is taken - the problem with TRAM appears that by taking the muscle out it weakens the abdemon wall and you can be subject to hernia’s and treatment for life. Has anyone else had experience of this type of reconstruction?ie DIEP/TRAM(Both).thanks

Hi Saffronseed, I saw a plastic surgeon on Friday and the TRAM and DIEP were definitely put to me as two similar, but separate options. He gave me a photocopy of his handwritten notes and has listed these two side by side with their advantages/disadvantages. He did say each option uses different blood supplies and they would check these beforehand I think, so may be one option would not be possible if the blood supply was unsuitable. I would think his letter still suggests either DIEP/or TRAM, although I’m a bit confused as the DIEP was put to me as the “free” flap with the blood vessels being reconnected to some from under the rib and the TRAM as a “pedicle” because they move the blood vessels along with it. This probably hasn’t helped much but hopefully he will clarify things for you when you seem him again. Good luck with your decision. BB

I had my reconstruction done on 30th June. I was due to have a DIEP flap, but ended up having a TRAM flap. It depends on where the blood vessels are and if the surgeon can remove them without disturbing muscle. In my case the blood vessels were intertwined with the muscle so both had to be moved together. I think the TRA muscle will recover over time but I have to wear support knickers for the next couple of months. I have been warned of hernia problems but understand this is a rare complication.
I think a lot of surgeons will not committ to either DIEP or TRAM until the operation is underway.
I am very happy with the results of the op, and although I am tired and sore, I am more mobile than I thought I’d be by this stage.
Hope this helps answer your question.

Et