Breast reconstruction with flaps from the lower abdomen

Background: The lower abdominal region offers a multitude of flaps for breast reconstruction, which include the pedicled and free transverse rectus abdominis myocutaneous flap (TRAM), the deep inferior epigastric artery perforator flap (DIEAP), and the superficial inferior epigastric artery flap (SIEA). Methods: This literature overview examines the history and the practice of breast reconstruction using flaps from the lower abdomen. All relevant studies and experiences have been included. Results: The decision-making process in regard of the choice of flap to use is complex and depends on a variety of factors. A clear trend in using flaps which lower donor site morbidity and higher aesthetic outcome is seen. Conclusions: This article serves to review surgical anatomy, preoperative planning, intraoperative decision making in flap elevation, and reported outcomes in terms of complications and patient satisfaction.