This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question. Question: I had a bilateral mastectomy in February 2013. Since that time, I went through expansion and implant procedures. Because my skin was thin, they ended up having to remove everything on the left side. Even after adding donor skin, it did not work. After researching, it seems that I would be a candidate for a DIEP flap procedure. My plastic surgeon is recommending the TRAM flap, but I am worried about taking muscle from my back. Can you please advise? Answer: I’m sorry to hear that you had some problems with your breast reconstruction. I’m wondering if you had radiation? Thank you for asking about the DIEP procedure. Unlike the TRAM procedure, the DIEP should not involve removing your muscles. The TRAM removes all or part of the tummy wall muscle known as the rectus abdominis muscle. The TRAM also uses the fatty tissue attached to the tummy muscle to rebuild the breast. The DIEP uses the lower tummy fat also but does not remove any muscle. It  also does not remove the back muscle. The back muscle is called the latissimus dorsi muscle and can be  used to help with implant problems.  In general, I would recommend the DIEP procedure for breast reconstruction because it should not sacrifice or remove the tummy wall (rectus abdominis )muscle. I would need more information about your situation to be more specific. Please let me know if you would like more information. Thanks for your question!

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