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Abdominal Flaps for Breast Reconstruction (DIEP, SIEA, and TRAM Flap Surgeries)

What Are Abdominal-Based Flaps?

Abdominal flap breast reconstruction surgeries use skin, fat, and sometimes muscle from the lower belly to rebuild the breast after mastectomy. This approach offers a natural look and feel using your own tissue, with the added benefit of a tummy tuck-like contour. 

Some common techniques include the TRAM flap and the SIEA flap. Compared to other natural reconstruction options like thigh- or buttock-based flaps, abdominal flaps often provide the most volume and are the most commonly used.

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PRMA - Abdominal-Based Flaps - What are Abdominal Based flaps

Abdominal Flap Reconstruction: Key Information

  • Uses skin and fat from the lower belly to recreate the breast.
  • Provides a natural look and feel using your own tissue.
  • Often includes the added benefit of a tummy tuck.
  • DIEP flap uses skin and fat only, no muscle, helping preserve core strength and support a faster recovery compared to traditional TRAM flaps.
  • TRAM flap uses abdominal muscle, fat, and skin, which may impact core strength and recovery time.
  • Muscle-sparing TRAM preserves more muscle to reduce abdominal weakness.
  • SIEA flap avoids muscle entirely and offers the easiest recovery, but is only an option if specific surface vessels are present.
  • Ideal for patients seeking long-term, implant-free reconstruction with natural results.
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Understanding Your Options

Regarding abdominal flap reconstruction, options like the DIEP, TRAM, and SIEA flaps offer unique benefits depending on your anatomy and goals. Learning the differences empowers you to make an informed, confident decision about what’s best for your body and your healing journey.

DIEP Flap

The DIEP flap uses your lower belly skin and fat, not muscle, to recreate a soft, natural-feeling breast. It offers beautiful, lasting results with minimal impact on core strength, making it a popular choice for women seeking both wholeness and a strong recovery.
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SIEA Flap

The SIEA flap also uses tissue from the lower belly but avoids cutting any muscle or deep blood vessels. It offers the least invasive option, providing a natural look and feel with the quickest recovery and lowest abdominal impact.
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TRAM Flap (Traditional)

This approach transfers belly fat, skin, and a portion of abdominal muscle to reconstruct the breast. It can be a good option when other flap types aren’t possible, offering a reliable result, though it may come with a longer recovery and some core weakness.
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TRAM Flap (Muscle-Sparing)

Designed to preserve more of your abdominal muscle than the traditional TRAM, this version helps reduce long-term weakness while offering the same natural tissue benefits, supporting your journey toward confidence with a balance of strength and softness.
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What to Expect During Surgery

At PRMA, two highly experienced microsurgeons work together to perform every natural tissue reconstruction, enhancing safety, shortening anesthesia time, and improving surgical precision. 

Surgeons begin by carefully removing the tissue needed from the lower belly. Only skin and fat are taken in a DIEP or SIEA flap, preserving the abdominal muscles. The difference lies in the blood vessels used: the DIEP uses deep vessels that require microsurgical precision, while the SIEA uses more superficial vessels when they’re present. In a TRAM flap, a portion of the abdominal muscle is included with the tissue, affecting recovery and core strength.

Once the tissue is removed, it’s transferred to the chest, shaped into a breast, and its blood vessels are meticulously reconnected under a microscope to ensure healthy blood flow. The surgeons then close the incisions, and patients are monitored as they begin healing.

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Before & After

See real results from women who’ve trusted PRMA with their reconstruction journey.
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Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction
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Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction
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Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction
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Before img-1
Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction
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Recovery Timeline

  • Week 1:
    After surgery, most patients stay in the hospital for 2–4 days. During this time, managing pain, monitoring the flap, and beginning gentle movement is the focus.
  • Weeks 2-4:
    At home, rest is essential, but light walking is encouraged to support healing. Swelling, bruising, and fatigue are completely normal at this stage.
  • Weeks 4-6:
    By this point, most patients notice improved mobility and energy. Depending on how they feel, many can return to non-strenuous daily activities or desk work.
  • Weeks 6-12:
    Light exercise may resume with your surgeon’s approval, though abdominal strain should still be avoided. Most patients feel a meaningful shift in their recovery—less fatigue, more confidence, and greater physical comfort. The breast shape continues to settle, and scars begin to soften.
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The Nation’s Destination for
Sensation Restoration

PRMA has transformed breast reconstruction with their revolutionary TruSense® procedure, a proprietary technique that restores breast sensation in qualified patients—giving back not just form, but feeling.
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Am I a Candidate for Abdominal Flap Reconstruction?

Abdominal flap reconstruction can be a great option for many women, especially those seeking a long-term, natural solution without implants. Whether it’s a DIEP, SIEA, or TRAM flap, these procedures use tissue from your lower belly to recreate the breast. However, candidacy depends on a few key factors.

You may be a candidate for abdominal flap reconstruction if:

  • You have enough skin and fat in the lower abdomen.
  • You prefer a natural alternative to implants.
  • You haven’t had extensive abdominal surgeries that may affect blood vessels.
  • You’re in generally good health and able to undergo a longer surgery.
  • You’re seeking a long-lasting reconstruction option with fewer future procedures.
  • You want a reconstruction that looks and feels more like your natural body.
  • You’ve had implant complications or are considering revision.
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Find Your Surgeon

PRMA’s board-certified, fellowship-trained microsurgeons perform over 1,000 DIEP flap procedures every year, making us one of the most experienced breast reconstruction centers in the world. Every surgery is performed by two microsurgeons, enhancing safety, precision, and outcomes—with a flap success rate of over 99%. With more than 15,000 reconstructions performed to date, our team delivers world-class expertise you can trust.
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Dr. Minas Chrysopoulo
Championing Advanced Breast Reconstruction Access Nationwide
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Dr. Gary Arishita
Dedicated to Restoring Confidence Through Expert Reconstruction
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Dr. Oscar Ochoa
Board-Certified Plastic Surgeon & Fellow of the American College of Surgeons (FACS)
gary-arishita
Dr. Gary Arishita
Dedicated to Restoring Confidence Through Expert Reconstruction
oscar-ochoa
Dr. Oscar Ochoa
Board-Certified Plastic Surgeon & Fellow of the American College of Surgeons (FACS)

Will Insurance Cover DIEP, SIEA, or TRAM Flap?

Thanks to the Women’s Health and Cancer Rights Act (WHCRA), most health insurance plans that cover mastectomy are also required to cover reconstruction, including natural tissue procedures. At PRMA, we’re proud to be insurance-friendly and accessible to patients nationwide, so you can focus on healing, not red tape.

For more information, visit [Insurance FAQs] in the patient resource center.

PRMA - Abdominal Flaps - Preparing for surgery

Preparing for Abdominal Flap Reconstruction Surgery

Whether you’re local or traveling in, we’re here to make your experience as smooth and stress-free as possible. Explore what to expect before surgery and how to plan your trip to PRMA.

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Preparing for Surgery
Travel Accomodations

Frequently Asked Questions

How do abdominal flap procedures compare to implants?
Abdominal flap procedures use your own tissue to recreate the breast, offering a softer, more natural look and feel than implants. They’re also more durable, with fewer long-term risks like rupture or replacement. 
Will my abdominal muscles be affected?
That depends on the type of flap. DIEP and SIEA flaps preserve your abdominal muscles completely. The TRAM flap, particularly the traditional version, does use some muscle, which may lead to a longer recovery and changes in abdominal function.
What will my scar look like after surgery?
Abdominal flap reconstruction typically leaves a horizontal scar low on the belly, similar to a tummy tuck scar. There will also be scars on the chest where the new breast is created. Our surgeons take great care to place incisions strategically and offer revision options down the road to help minimize their appearance over time.
How long will I need to wait before returning to daily activities?
Most patients can return to light activities within 4–6 weeks and resume full routines, including exercise, by 8–12 weeks.

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