Information on Different Reconstruction Procedures IMPLANTS: Implants currently filled with Saline, so if a perforation should occur, there are no negative side affects to your body. This procedure whether done immediately following a mastectomy, or done at a later date, requires the use of skin expanders. This is accomplished by starting with small implants and gradually inserting fluid till the proper size is achieved. This then requires a surgical procedure to install the final implant. Potential problems: The implant could leak, causing surgery to replace. Sometimes the implants become hard. TRAM Flap Procedure: The TRAM (transverse rectus abdominus myoctaneous) Flap takes the skin, the fat, and the entire rectus muscle from the abdominal area to be utilized for the reconstruction. The muscle only serves as the carrier of the blood supply to the skin and fat. The flap, attached only by muscle at the ribs, is folded on to itself and tunneled up under the upper stomach skin onto the chest. It is then shaped into a breast. Pulling the rest of the abdominal skin down like a window shade, closes the abdomen. Potential problems: Bulge of the folded muscle under the ribs and abdominal weakness or hernia formation. This procedure uses the muscle to supply blood, but like any other muscle that is not used it atrophies or wastes away. The patient gives up perfectly good muscle that's only used for blood flow. Free TRAM Flap: In the Free TRAM Flap procedure, only a small piece of muscle is used, along with the fat and skin. This procedure cuts the muscle, fat, and skin, both top and bottom, then uses micro surgery to reestablish blood flow to the area. Potential Problems: There is still a chance for a hernia with this procedure. DIEP Flap: The DIEP (deep inferior epigastric) Flap procedure only uses fat and skin from the abdominal area. This procedure requires no muscle be removed with the fat and skin. The fat and skin are surgicaly removed from the abdominal area and the reattached, using micro surgery to conect it to the chest area. Actual OR footage of this procedure can be viewed at http://www.or-live.com/bethisrael/1896/index.cfm?r=orlive. It has also come to my attention that there is a new way to noninvasively measure the health of a Diep Flap post operatively. You can read about this at www.vioptix.com . Potential Problems: The length of the operation. Few surgeons do this procedure due to the expense of extra training and equipment.