Update on Breast Reconstruction Using Free TRAM, DIEP, and SIEA Flaps

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Autologous breast reconstruction commonly uses the transverse rectus abdominis myocutaneous (TRAM) flap.
• Microvascular surgery advanced TRAM flap techniques, leading to free TRAM and muscle-sparing variations (DIEP, SIEA) to reduce donor site morbidity.
• Muscle-sparing techniques aim to preserve the rectus abdominis muscle and fascia.

Purpose of the Study:

• To review the evolution and outcomes of autologous breast reconstruction flaps.
• To compare the effectiveness of different flap techniques regarding abdominal donor site morbidity and functional outcomes.
• To highlight the potential of the SIEA flap and sensory nerve coaptation.

Main Methods:

• Review of accumulated data over the past decade on TRAM, free TRAM, DIEP, and SIEA flap techniques.
• Analysis of postoperative abdominal strength, bulging, hernia risk, and patient-reported functional impairments.
• Evaluation of sensory nerve coaptation for improved breast sensation.

Main Results:

• Muscle- and fascia-sparing techniques, like DIEP flaps, show improved postoperative abdominal strength.
• Muscle-sparing techniques do not significantly decrease the risk of abdominal bulging or hernia.
• No significant differences in patient-reported abdominal weakness or functional impairments were found between techniques.
• The SIEA flap is emerging as a method to virtually eliminate abdominal donor site morbidity.

Conclusions:

• While DIEP flaps offer better abdominal strength, they don't eliminate hernia risk.
• The SIEA flap presents a promising option for minimizing abdominal donor site morbidity in breast reconstruction.
• Sensory nerve coaptation is a relevant consideration for enhancing reconstructed breast sensation.