No abstract

Abdominal complications following breast reconstruction with a pedicled transverse rectus abdominus myocutaneous (TRAM) flap include decreased abdominal strength, bulge and hernia, pain, and difficulty with lifting, housework, work, and sport. Research work has shown that the muscle-sparing free TRAM flap does not necessarily prevent these complications, as removing a portion of one rectus abdominis reduces the integrity of the whole donor muscle. The deep inferior epigastric perforator (DIEP) flap was developed in an attempt to minimize donor site morbidity, and trials that have been conducted comparing the free TRAM and DIEP flaps suggest that the DIEP flap does have less impact on abdominal muscle strength and function, although problems can still occur. Recent work by the author confirms that the DIEP flap does reduce donor site morbidity and that an additional benefit in terms of a subjective improvement in outcome can be obtained from preoperative abdominal exercises. Progressive postoperative abdominal exercises and advice on posture and returning to functional activities from a physiotherapist familiar with the surgical techniques are recommended to ensure optimal outcome.