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.
KEYWORD
Abdominal weakness - muscle strength - function
