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Breast Reconstruction Blog

Both the transverse rectus abdominis musculocutaneous (TRAM) and the deep inferior epigastric artery perforator (DIEP) flaps utilize abdominal tissue to reconstruct the breast.

It is helpful to think of a TRAM flap as the first generation DIEP flap. In a TRAM flap, the lower abdominal skin is transported to the chest while remaining attached to the rectus or “6-pack” muscle. In this operation, the muscle is freed from its sheath and released from its attachments at the pubic bone. The muscle and skin can then be folded upwards and tunneled beneath the chest skin to provide tissues that can be used to reconstruct the breast. While the procedure is usually successful, there can be times that the blood supply may be inadequate and the tissue will fail. This stems from the fact that the rectus muscle has a blood supply that enters from both the top and from the bottom of the muscle. In a TRAM flap, the lower blood supply is divided to allow the tissues to be folded upwards. This then makes the tissues used to make the breast quite far from the origin of the blood vessels used to supply the flap which are left intact at its top. This anatomical arrangement can lead to the death of the tissues and loss of the flap. Additionally, the change in position of the muscle can lead to abdominal weakness and potential hernia formation. Most plastic surgeons have the skills necessary to perform this operation as the blood vessels that nourish these tissues remain intact.

The second generation represents a free TRAM. In this procedure, the skin of the lower abdomen is lifted using a portion of the rectus muscle and the lower blood supply to the muscle. This represents a personal transplant and the blood vessels are reattached under the microscope either in the chest or the armpit. This helps reduce problems associated with distant blood vessels and decreases the risks of partial or total flap death. Additionally, only a small portion of the muscle is used and the risks for abdominal weakness and hernia formation are reduced.   Plastic surgeons who perform this procedure have additional expertise in breast reconstruction and many of them have completed additional training in microsurgery.

The final generation of the TRAM flap is the DIEP flap. In this procedure, the abdominal tissues are transplanted using the blood vessels alone. No muscle is taken during the operation and a goal is to preserve the nerves entering it so that it remains functional. This further reduces the problems of abdominal weakness and hernia formation. Plastic surgeons performing DIEP flap breast reconstruction have an even higher level of expertise and will often use similar principles for other types of reconstruction in their practice.

For more information about TRAM flaps, DIEP flaps, or breast reconstruction I invite you to schedule a consultation with either myself or my partner. Please feel free to contact our office at (972) 566-3939 if you have any questions.

-Brice W. McKane, M.D.

Chemotherapy is used to help treat cancer. It uses certain types of drugs to help prevent the spread of cancer by killing cancer cells or slowing their growth. It can also be used to help treat some of the symptoms of cancer or problems caused when cancer spreads to other parts of the body. Chemotherapy is often part of a treatment plan that may include surgery and radiation therapy. Neoadjuvant chemotherapy is given before surgery and is used to shrink a tumor so that it can be removed with less injury to surrounding tissues. Adjuvant chemotherapy is given following your resection and breast reconstruction surgery or radiation and is used to help destroy any cancer cells that are left behind at the time of surgery. Additionally, chemotherapy can be used if your cancer returns.

Cancer develops when changes occur in a normal cell to cause it to begin to grow out of control. Chemotherapy works by targeting certain phases of a cell’s growth cycle to disrupt this process. To maximize this process your treatment is likely to use more than one chemotherapy drug. This is called combination chemotherapy. Side effects from chemotherapy occur because the drugs cannot distinguish between cancer cells reproducing and normal cells reproducing to replace older cells. During chemotherapy the cells most likely to be damaged are those that are growing rapidly. These include the cells of your bone marrow which can lead to anemia or problems with bleeding and your white blood cells which can lead to a problem called immunosuppression which may make you more prone to developing and having difficulty fighting infection. Chemotherapy can also affect the cells within your hair follicles responsible for producing your hair and this explains the hair loss which may occur. Additionally, cells lining the digestive and reproductive systems can be affected.

Chemotherapy affects people differently. Some will be able to continue work or school and continue with their normal routines. For others, side effects can be quite limiting and may force you to adjust your routine or the timing that the therapy is given.

If you are experiencing fatigue or other side effects from chemotherapy, there are federal and state laws which may require your employer to accommodate you regarding your work schedule during your treatment. A good resource for this information is the American Cancer Society which can be reached at 1-800-227-2345,

For more information about chemotherapy and how it may impact breast reconstruction I invite you to schedule a consultation with either myself or my partner. Please feel free to contact our office at (972) 566-3939 if you have any questions.


-Brice W. McKane, M.D.

Dallas Breast Reconstruction Team

Our office had a team at and participated in the Komen Race for the Cure in Plano Texas on Saturday, the 8th. It was, as usual, a lot of fun and inspirational

Texas Center for Breast Reconstruction team


Dr. McKane and Dr. Duffy



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