Which of the following breast reconstruction flaps has the best outcome? TRAM flap, Muscle sparing free TRAM flap, DEIP free flap?
The breast outcome is roughly the same. But the abominal outcome differs, the DIEP flap has the lowest morbidity on the rectus muscle and therefore the lowest rate of herniation...
If possible it's better to avoid the TRAM flap.
Between the free MS TRAM and the DIEP, the choice depend of the intramuscular route of the deep inferior epigastric vessels and the perforators size.
I Agree with Jean-Philippe.
Naturally classic TRAM flap is a simpler and faster procedure.
It's all about what you're comfortable with, actually. From the patient's point of view, DIEP is the hands down winner with its minimal functional morbidity and providing a like-tissue substitution of the defective organ. However, it can only be possible if the surgeon is comfortable with perforator identification and dissection. In other words, there's nothing wrong with going through with a TRAM or MS TRAM if the surgeon is not experienced in perforator flap surgery.
