Breaking down the similarities and differences of common natural breast reconstruction procedures. With all the advancements in recent years, there are now so many options for natural breast reconstruction. When figuring out the kind of surgery you should have, it’s very important to understand the difference between procedures that may seem similar. Flap-based surgeries most commonly use tissue from the lower abdomen to reconstruct the breasts after mastectomy. These procedures all utilize the same donor site area, but they are vastly different in the techniques they use, the results they yield, and the expertise required to successfully perform them. Transverse Rectus Abdominis Myocutaneous (TRAM) flap reconstruction was developed in the 1980s as one of the first alternatives to implant-based surgery. TRAM procedures can be performed using either a “pedicled flap” or a “free flap” technique. Pedicled TRAM flap reconstruction moves skin, fat, and muscle from the abdomen to recreate the breasts. Leaving the donor site blood vessels attached to the flap, this tissue is tunneled through the abdomen to the chest. This surgery requires an extensive recovery period because it uses a large amount of muscle from one side (single pedicled flap) or both sides (bi-pedicled flap) of the abdomen. This type of procedure also comes with a higher rate of postoperative complications, including abdominal bulging, hernia formation, and residual muscle weakness. During free flap TRAM reconstruction, the abdominal tissue is fully detached, and the blood supply from this area is preserved to the flap. The blood vessels from the abdomen are then connected to the vessels at the recipient site. While this surgery is frequently called “muscle-sparing,” this label can be especially misleading. Free flap TRAM reconstruction does require muscle; it just uses a smaller amount, often referred to as the size of a postage stamp. Deep Inferior Epigastric Perforator (DIEP) flap reconstruction uses tissue from the same area as TRAM surgeries. However, it does not require muscle, making it the only truly “muscle-sparing” option for abdominal flap procedures. Instead, a team of specialized surgeons forms the flap using only skin and fat from the abdomen, removing the necessary blood vessels through the muscle. These vessels are then divided and preserved until they are connected to the mastectomy site. Because the DIEP flap only uses skin and fat from the abdomen and never uses muscle, this surgery doesn’t adversely affect muscle function and needs a shorter recovery time. Unlike both types of TRAM reconstruction, serious donor site issues aren’t common with DIEP procedures. While these procedures seem so alike, their differences are quite essential to their results and your quality of life. These distinctions can really mean a lot, especially for your health and your future. Our goal is to provide you with the information you need to make smart, informed decisions. To learn more, contact us at or via chat on our website - Emily Lanter