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Breast Reconstruction with Flap Procedures

A flap procedure uses your own tissue to form the shape of a breast. Common types of flap procedures are the TRAM flap and the LD flap. A DIEP flap may also be done. Less often, tissue may be moved to the chest from the buttocks or thigh.

These surgeries are named based on what part of the body the flap tissue is taken from.

Flap reconstruction surgeries leave you with 2 surgical wounds: the chest and the site where tissue was taken. 

Getting breast reconstruction surgery

Your surgeon can help you decide whether to have reconstructive surgery and what type is best for you. You might be advised to wait if now is not the best time for you. For instance, you may be advised to wait if you need to get radiation to your chest after surgery.

Breast reconstruction might not be an option if you smoke, have a connective tissue disease, have uncontrolled diabetes, or have circulation problems. These things can cause blood vessel problems, and healthy blood vessels are needed to support the tissue flap.

Talk with your healthcare provider about what the surgery is like and what you can expect after surgery. Also be sure you know what your breast shape will look and feel like and how the donor flap site might be affected.

TRAM flap

TRAM stands for transverse rectus abdominis myocutaneous. A TRAM flap uses stomach muscle, fat, blood vessels, and skin.

The flap is taken from the lower part of your stomach. It may be tunneled under your skin from your stomach to your chest. Or it may be cut free and moved there. The flap is then formed into the shape of a breast. The new breast shape feels soft to the touch. This surgery also makes your belly flatter and tighter, as if you had a "tummy tuck." It can also decrease the strength in your belly muscles.

Front view of female breasts and abdomen showing TRAM flap breast reconstruction.
TRAM flap

LD flap

The LD (latissimus dorsi) flap uses muscle, fat, and skin from your upper back. The flap of skin and fat is taken from the back side of your body, over your ribs. The latissimus dorsi muscle is left attached to the flap. Then the flap is tunneled under your skin to your chest. There, it's formed into the shape of a breast. The new breast feels soft to the touch. In many cases, an implant is needed with this surgery. 

Side view of female chest showing LD flap breast reconstruction.
LD flap

DIEP flap

DIEP (deep inferior epigastric perforators) flap uses fat, skin, and blood vessels from your lower belly to rebuild your breast. No muscles are used. Since no muscles are used, DIEP flap may have a shorter recovery time and less risk of losing muscle strength compared to a TRAM flap.

Risks of flap reconstruction

Any type of surgery has some risk. Some problems linked to breast reconstruction with a flap are: 

  • Bleeding

  • Fluid collection in either surgery spot (called a seroma)

  • Anesthesia problems (problems with the medicines used to do the surgery)

  • Bruising and swelling

  • Implant problems 

  • Infection

  • Muscle weakness

  • Scars and scar tissue under your skin

  • Problems at the donor site, such as muscle weakness or abdominal hernia (with TRAM flap)

Your surgeon will talk with you about the risks of surgery. Ask all your questions so you understand what breast reconstruction will be like during and after surgery. This way you can make the decision that's best for you.

Online Medical Reviewer: David Lickstein MD
Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Louise Cunningham RN BSN
Date Last Reviewed: 10/1/2020
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