Muscle removed from abdomen during DIEP surgery

Delo3865

I have DIEP scheduled for surgery on June 10th.  The surgeon tells me he may have to remove a chunk of muscle from my adbomen in order to remove the artery that will be used in my chest.  Has anyone had this done as part of your DIEP surgery?  If so, what effects have you experienced after your body healed from the surgery? 

Akevia

Hello Delo your PS is doing the TRAM flap on you not the DIEP flap. The difference is the removal of the abdominal muscle.

carol57

Delo, my surgeon did that as well. Many women in this forum travel some distance to have their flap recons done where the surgeons guarantee they will not remove muscle, and I was not aware of that option when I had my surgery.  However, I have only minor effects from the muscle loss, which was described to me as about the size of a dime. I was told that taking the muscle helps support the artery at its weakest point, i.e. where it was always supported by muscle.  Anyway, the only side effect that I notice is that I cannot do a sit-up from a fully flat position. I can do crunches and if I start from even the tiniest trunk elevation, no problem. But there seems to be about a 10-degree segment of my range of motion that just doesn't budge.  I've read that cutting the nerves to release the artery, with or without taking muscle, can cause a small portion of muscle paralysis, but of course I can't know if this would have happened had my muscle been left intact. 

This side effect has zero effect on my daily life, and I'm a real gym rat, working out several times a week with weights and with a trainer who has no pity on my (knowing full well all the details of the surgery).  I find that I feel tugging and pulling internally, presumably the scar tissue on the fascia, when I do work that puts a lot of stress on the transverse abdominal muscle--but I can still do it, and I have very strong abs.  I know you'll hear from others here, and good luck deciding if you want to go this route or seek a surgeon who promises to leave the muscle intact.

carol57

I think when they take the 'coin' of muscle, they code the surgery as a muscle-sparing TRAM flap, even as they call it a diep reconstruction in conversation. But there's a big difference between a TRAM flap, when they use the entire rectus abdominus, and the muscle-sparing version when they take a small portion of the muscle.  You sure do want to find out exactly which version the surgeon is talking about.

goodrhue

In my consult with Dr. Holleman at Duke 2 weeks ago, he explained to me that when they are "teasing" the blood vessels out of the abdominal muscle during a DIEP, sometimes if the vessels are many and tiny, instead of a few nice big ones, the "teasing" can damage the abdominal muscle, with the potential for impacts similar to removing the muscle.  This apparently happens less and less often as the surgeons gain more experience, but it is a risk.