Excess cutaneous sub-umbilical abdominal fat or a protruding abdominal pouch over the pubis, are the best conditions for making such a flap.
Breast reconstructed with autologous tissue without prosthesis has the advantage of aging in the same way as the breast of the opposite side.
The scar of the flap of rectus abdomen (TRAM FLAP: Transverse Rectus Abdominis Muscle) is ideally located in the suprapubic region as when performing an abdominoplasty. A periumbilical scar is associated.
The procedure is long and heavy with risk of thromboembolism being significant.
The sequelae of the abdominal wall risk rupture or a bulging parietal, despite the systematic use of a plastic plate for strengthening the abdominal muscle.
Partial necrosis of the flap occurs in some cases, with the possibility of reoperation on the 10th postoperative day.
To reduce these risks at the abdominal wall and the localized necrosis of the flap, a flap-type micro-surgical DIEP (Deep Inferior Epigastric Perforator) can be proposed. This procedure is done ideally in hospital and requires careful monitoring.
It is an identical flap with the same cutaneous fat palette but without sacrificing abdominal muscle with micro-surgical anastomosis inferior epigastric vessels providing blood supply to the flap vessels in the armpit.
In this case, the abdominal wall is solid, without the use of a synthetic plate and with significantly reduced risk of necrosis in the flap. This procedure (DIEP) is long and can last between 6 to 8 hours. It should be reserved for trained surgical teams, mastering the techniques of micro-surgicology.
Before breast reconstruction
Severe consequences of radiotherapy.
Lack of scar flexibility.
After breast reconstruction by flap of rectus abdominal pedicle without prosthesis.
Belly favorable with excess fat.
Outcome at 3 months.
After breast reconstruction by flap of rectus abdomen.
Final outcome at 6 months. Left breast augmentation with 200 gram round silicone gel prosthesis and reconstruction of the areola and nipple skin graft.