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Hernia After TRAM Flap or DIEP Flap Reconstruction

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If you had a TRAM flap or DIEP flap breast reconstruction surgery, you have a small risk of developing an abdominal hernia.

A hernia occurs when part of an internal organ (often a small piece of the intestine) bulges through a weak spot in a muscle. Most hernias are in the abdomen.They usually develop when someone who has a weak spot in an abdominal muscle strains the muscle, perhaps by lifting something heavy.

Hernias can be painful and can cause a noticeable bulge in your abdomen. TRAM flap or DIEP flap surgeries increase your risk of hernia because they can weaken the abdominal wall.

Hernia risk with TRAM flap

TRAM stands for transverse rectus abdominis muscle, a muscle in your lower abdomen between your waist and your pubic bone. In a TRAM flap procedure, a flap of skin, fat, and all or part of the underlying rectus abdominus (“6-pack”) muscle are used to reconstruct the breast.

Your risk of hernia is higher if you had a “free TRAM flap” surgery or “a pedicled TRAM flap” surgery than if you have a “muscle-sparing free TRAM flap” surgery, because more muscle was moved to rebuild your breast so your abdominal muscles may be weaker. However, any type of TRAM flap surgery involves removing some muscle.

Hernia risk with DIEP flap

DIEP stands for the deep inferior epigastric perforator artery, which runs through the abdomen. In a DIEP flap reconstruction, fat, skin, and blood vessels are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. In a properly performed DIEP, no abdominal muscle is cut or removed.

Your risk of hernia is much lower with a DIEP flap surgery than with any type of TRAM flap surgery.

A newer type of DIEP flap operation known as APEX flap surgery also carries a low risk of hernia. APEX stands for abdominal perforator engineered vascular exchange. In an APEX flap procedure, the surgeon rearranges the blood vessels in the flap before moving it to improve blood flow without damaging the abdominal muscles. Still, after any abdominal surgery, there is some risk of hernia.

Treatment for abdominal hernia

Hernias are usually treated by surgically repairing the opening in the muscle wall. A plastic surgeon or a general surgeon can perform the surgery.

A procedure to repair a hernia that occurred after a DIEP or TRAM flap surgery will typically be an “open repair” (not a laparoscopic or robotic repair). Using the same abdominal scar from the earlier flap surgery, the surgeon will make an incision and push the tissue that is bulging out of a weak spot in the abdominal wall back into the abdominal cavity and may tie off or remove the sac that held the hernia. Then the surgeon will strengthen the abdominal wall with stitches and/or mesh, or by rearranging the abdominal muscles.


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