Hernia After TRAM Flap or DIEP Flap Reconstruction

After DIEP or TRAM flap reconstruction surgery, there is a small risk of abdominal wall hernia or weakness. A hernia is a hole or weakness in a muscle wall (often the abdominal wall) that allows part of an organ (such as the intestine) to bulge out.

DIEP flap and TRAM flap hernia symptoms are similar. There may be a noticeable bulge in your abdomen. You might also feel:

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  pain

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  nausea

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  cramping

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  bloating

DIEP flap reconstruction is a muscle-sparing procedure, which means surgeons don't have to cut into any muscle to create the flap when reconstructing the breast. Sparing the muscle helps to lower the risk of a hernia.

In rare cases, the nerves that control the abdominal muscles can become compromised. A hernia might develop if the abdominal wall weakens too much as a result of impaired nerve function.

During a TRAM flap procedure, the surgeon has to take all or part of the underlying abdominal muscles (your six-pack) in addition to skin and fat from the same area to reconstruct your breast. Since TRAM flap surgery does not spare the muscle, it can weaken the abdominal wall and increase your risk of hernia. The risk of hernia is greater with a TRAM flap procedure than it is with a DIEP flap procedure.

Sometimes abdominal problems after DIEP flap procedures are temporary because they’re related to the nerves rather than the abdominal muscles. Depending on how severe a hernia is, your surgeon might recommend:

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  physical therapy

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  microsurgery to repair the nerves

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  reinforcing the lower abdominal wall with supportive mesh

If you get a hernia after a TRAM flap, you are likely to need surgery to repair the opening in the muscle wall. A plastic surgeon or a general surgeon can perform the surgery. Surgeons typically use the same abdominal scar from the TRAM flap surgery to do an open repair, rather than a laparoscopic or robotic repair, which requires a much smaller incision.

After pushing the tissue that is bulging out of the weakened spot in the abdominal wall back into the abdominal cavity, the surgeon either ties off or removes the sac that held the hernia. The surgeon then strengthens the abdominal wall with stitches, mesh, or both, or by rearranging the abdominal muscles.