[Preservation of the muscle in the use of rectus abdominis free flap in breast reconstruction: from TRAM to DIEP (Deep inferior epigastric perforator) flap. Technical notes and results].

The advantages of TRAM (Transverse Rectus Abdominus Muscle) flap for breast reconstruction is now well recognised. This technique allows a cosmetic reconstruction with a more natural shape than with conventional reconstruction with prosthesis. However the disadvantage is the need of removal of part or all rectus abdominis muscle. If the techniques of free flap are now recognised to be more reliable than pedicle TRAM they have not demonstrate a superiority in term of parietal sequellae. To avoid such problem some teams have progressively developed the DIEP (Deep Inferior Epigastric Peforator Flap). This flap is harvested only on the transmuscular perforators. We are presenting here our expertise which progressively has leed us from free partial TRAM to DIEP. From december 1995 to january 1997 we have practice 18 breast reconstructions with free flap. On 13 DIEP we had only one parietal complication due to incomplete closing of the aponeurosis at the lowest part of the surgical approach. This complication was easily corrected as the muscle was still tonic. On 5 TRAM, clinical examination finds parietal weakness on 3 cases. We believe that this technique is full of promises as it brings autologous tissue with no complication on donor site.