Woman resting chin on folded hands

DIEP Flap vs TRAM Flap

Women seeking breast reconstruction using their own tissue should understand the benefits of DIEP flap versus TRAM Flap.

The older TRAM method is rarely employed by Oren Z. Lerman, MD, who prefers the benefits of the less invasive DIEP flap procedure.

Learn why Dr. Lerman in Manhattan, NY, often recommends DIEP flap surgery over other autologous methods...

Natural Tissue Options For Breast Reconstruction

Using a flap of tissue from a patient's own body is an alternative to using breast implants. DIEP and TRAM flap procedures both take tissue from the abdomen to reconstruct a breast, but the techniques differ in important ways. Dr. Oren Lerman can patiently explain all your options during a consultation at our Manhattan practice. 

DIEP Flap and TRAM Flap: What Is the Difference?

The most common type of natural (autologous) tissue reconstruction performed in the community is the older TRAM flap procedure, which was first described in 1979. However, advances in microvascular surgery have introduced more refined techniques for autologous breast reconstruction. 

State-of-the-Art DIEP Flap

Today, microvascular surgeons like Dr. Lerman avoid the TRAM flap in favor of the more advanced DIEP flap method. The state-of-the-art DIEP flap technique minimizes donor site morbidity, which can lead to abdominal wall weakness or hernia. Being less invasive, the DIEP method also cuts down on recovery time while providing a superior result.

Helping Patients Make Informed Choices

The TRAM flap technique is still part of Dr. Lerman's surgical repertoire. However, as director of breast reconstruction at the Institute for Comprehensive Breast Care at Lenox Hill Hospital in Manhattan, NY, he helps educate patients about the benefits of the advanced DIEP flap versus the TRAM flap to ensure that patients make informed decisions about their breast reconstruction.

Dr. Lerman Discusses Flap Reconstruction

Diep flap reconstruction allows for breast reconstruction using your own natural body tissues. Dr. Lerman specializes in breast reconstruction, including natural breast reconstruction. He has the expertise to perform this procedure for more candidates than many other plastic surgeons.

Are You Considering Breast Reconstruction Using Your Own Natural Tissue?

If you are considering using natural tissue for breast reconstruction, Dr. Lerman is an exceptionally qualified microvascular and plastic surgeon who strives to provide patients with the highest level of care. Dr. Lerman's distinctions include:

  • Director of Breast Reconstruction at Lenox Hill Hospital's Institute for Comprehensive Breast Care in Manhattan
  • Director of the Breast Aesthetic and Reconstructive Fellowship
  • Board-certified by the American Board of Plastic Surgery and a diplomat of this prestigious organization 
  • Advanced surgical training fellowship in Microvascular Surgery and Breast Reconstruction at the University of Pennsylvania
  • Consistently recognized as a top Manhattan plastic surgeon by Castle Connolly Top Doctors, Super Doctors®, and New York Magazine

For more information about the benefits of the DIEP flap versus the TRAM flap, or to discuss which reconstructive surgery will work best for you, contact Oren Z. Lerman's practice in Manhattan today:

(212) 434-6980

woman covering breasts
Dr. Lerman's goal is to make you look as good or even better than you did before surgery.

"He has my highest recommendation" 5-Star Reviews from Satisfied Patients


Kleigh NYC


Google logo

Dr. Lerman is best of the best! From his bedside manner and ability to really listen to his patients to his highly skilled surgical hand, I am so grateful and fortunate to have found him. He has my highest recommendation, as well everyone on his staff. Helpful and lovely to deal with. 5 stars!

View On Google

Beth Stern


Google logo

I came to see Dr. Lerman having begun the implant process post mastectomy but very unhappy with the tissue expander. I had constant discomfort and a misshapen breast. Within hours of flap surgery, my pain was gone. I am so thankful!

View On Google

A Detailed Look at Tissue Selection

Both the DIEP and TRAM flap surgeries harvest tissue from the lower abdomen. The primary difference between the two procedures is whether muscle is removed in addition to skin and fat.

Let's take a closer look at how tissue transfers in these two methods differ and how they can affect the outcomes:

TRAM Tissue Transfers

In the more traditional TRAM flap surgery, rectus muscle is taken from the abdominal wall and transferred to the breast. The rectus is one of the core abdominal muscles. It helps you do sit-ups and creates the famed "6-pack" in bodybuilders.

However, removing muscle from the abdomen comes with some added risks: 

  • Because the muscle is cut, there is a significantly higher chance of developing abdominal wall weakness, bulging, or even a hernia that needs to be corrected surgically.
  • Recovery is often longer and more painful.

The traditional TRAM procedure has evolved into what we now call the "muscle-sparing" free TRAM flap surgery (msTRAM), but surgeons still cut the muscle to do this muscle-sparing technique – just a smaller portion. Unfortunately, because no two patients or surgeons are alike, it is difficult to predict how much muscle is cut in a muscle-sparing TRAM operation.

tissue transfer

DIEP Tissue Transfers

The DIEP flap procedure developed as microvascular surgeons became better and better at harvesting the tissue without any muscle or the supportive outer layer around the muscle called the fascia.

During a DIEP flap procedure, the abdominal muscle and fascia are preserved entirely in the abdomen. Only skin, fat, and blood vessels are transferred to the breast. 

This method requires more advanced training and skill, but it:

  • Minimizes the risk of post-op abdominal wall weakness, bulging, or hernias
  • Reduces recovery time and discomfort

Dr. Lerman completed a surgical fellowship in microvascular surgery and breast reconstruction, and is one of the few plastic surgeons in Manhattan who is able to offer this advanced method of natural tissue breast reconstruction.

tissue transfer

Frequently Asked Questions About Autologous Breast Reconstruction

Do I Have Enough Tissue?

A common misconception is that you need to be overweight to have this surgery. This is not the case. There simply needs to be enough tissue to perform the reconstruction. While patients are sometimes told by other surgeons that they do not have enough tissue, Dr. Lerman has often found this to not be the case. 

One simple consultation is all that is necessary to determine if you are a candidate.

There are people who truly do not have enough abdominal tissue to use and in these cases, Dr. Lerman can often find alternative flap sites, such as the thighs (PAP or TUG flaps), buttocks (GAP flap), or even multiple sites (stacked flaps). 

Can I Replace Implants With My Natural Tissue? 

Many patients who have already undergone breast reconstruction in the past with implants and have complications from those implants or are dissatisfied with the shape, feel, appearance, and symmetry of the implants can have those implants removed and replaced with a DIEP flap or other flap procedure.

What If I Didn't Have Reconstruction?

Patients who never undergone any type of reconstruction at the time of their mastectomy may also undergo a DIEP flap procedure in what is called a Delayed Reconstruction. 

Speak with a Leader in Breast Reconstruction  Restore Your Form, Beauty, & Confidence

Dr. Oren Lerman is committed to helping breast cancer survivors following a mastectomy. If you are looking to use your own tissue for breast reconstruction, Dr. Lerman is at the forefront of microvascular techniques that achieve long-lasting, natural-looking results.   

He is a recognized leader in breast reconstruction who performs perforator flap surgery techniques including DIEP flapPAP flap, and GAP flap. Dr. Lerman also provides breast implant reconstruction

Throughout his career, he has become known for his caring, warm manner that encourages the two-way conversations that are essential to a successful outcome. To book your consultation, contact Dr. Lerman at his Manhattan practice: 

(212) 434-6980

Dr. Oren Lerman
Dr. Oren Lerman is an authority on breast reconstruction.

"I feel lucky and blessed to call him my doctor" A Trusted New York Plastic Surgeon Providing Perforator Flap Surgery


Kimberly del Gaizo


Google logo

He masterfully navigated my demanding journey with breast reconstruction following my cancer diagnosis and double mastectomy. As my body persisted in presenting formidable challenges, Dr. Lerman never wavered in his thoughtful and methodical decisions and treatments. Dr. Lerman is the ideal doctor. I feel lucky and blessed to call him my doctor.

View On Google



Google logo

Dr. Lerman changed my life! After a double mastectomy, he did reconstruction via DIEP flap. My fears were quelled by his excellent care. His staff is amazing. They saw and spoke with me throughout my recovery. I could not be happier with the results. Thank you!

View On Google

A Patient's Perspective On Breast Reconstruction

Error: No $video_url from $page_url
URL or code copied from YouTube, Vimeo and other video sites should be entered in the Video field

A patient discusses her exceptional breast reconstruction experience with Dr. Oren Lerman. Dr. Lerman immediately put her at ease with his caring manner and attention to detail. He spent a great deal of time explaining all of her options and making her feel comfortable with her surgery.

A Closer Look At The DIEP Procedure

DIEP stands for Deep Inferior Epigastric Perforators. The name of the technique comes from the specific blood vessels (perforators) that are removed from the lower abdomen as part of the tissue transfer.

Because of the numerous aspects that entail performing microvascular surgery, the DIEP flap procedure is a relatively long procedure. However, because the surgery is only on the skin, fat, and abdominal wall and not on any of the internal organs (lungs, heart, bowel), it is not a very invasive surgery and the recovery is significantly shorter than commonly described.


During the procedure, your surgeon removes the fat and skin from the lower belly to transplant it up to the chest wall and create a new breast mound. Because DIEP surgery is a free flap procedure, the tissue and its blood vessels are completely disconnected from the original blood supply and reattached up in the chest using a microscope.

Accessing the Blood Vessels

In order to access the blood vessels in the donor site, a small incision is made in the abdominal fascia surrounding the muscle. The muscle is left intact and the vessels that live behind the muscle are cut and transferred with the other tissue. The incision in the abdomen is then closed and reinforced so that it heals without any weakness.

Transplanting the Free Flap

The "free flap" is then transplanted up to the mastectomy site on the chest.

Re-Establishing Blood Flow

The most delicate part of the surgery is reconnecting the blood vessels in the transferred tissue to those in the chest. Known as microvascular anastomosis, this portion of the procedure requires surgeons to individually match up and sew together both the artery and the vein of the flap.

Tummy Tuck 

As an added benefit, a DIEP free flap procedure also functions as a tummy tuck. Removing skin and fat from the lower abdomen leaves patients with a slimmer and improved contour. Many patients are pleased with the combination of a reconstructive and recontouring surgery that often leaves them looking better than they did before surgery.

The TRAM Procedure

The specifics of a TRAM flap procedure depend on whether your surgeon uses the free flap, muscle-sparing, or pedicle technique:

Free-Flap Tram

The abdominal tissue and blood vessels will be transplanted just as they are in the DIEP flap but the tissue section will also include a portion of the rectus, more commonly referred to as the “six-pack” muscle.

Muscle-Sparing Free Flap

The muscle-sparing technique is a type of free flap procedure that removes a much smaller portion of the muscle.

Pedicle Flap

The transfer remains attached to its original blood supply. Instead of moving the tissue externally, your surgeon will tunnel it up to the chest beneath the skin of the upper abdomen. In this case, the entire rectus muscle will be transferred, as well.

Before closing up the abdominal incision, your surgeon may decide to cover up any open areas in your abdominal tissue with mesh material. This will help to support your abdominal wall and minimize complications after surgery.

"I highly recommend Dr. Lerman" Five-Star Reviews from New York Patients


I Am Liz Marie


Google logo

Dr. Lerman is an outstanding amazing surgeon. Very nice and patient. Communicated my options and what was best for me. Made me feel comfortable and confident in my skin again. I highly recommend Dr. Lerman. I am so thankful.

View On Google

Dana M. Panzer


Google logo

Dr. Lerman is an outstanding surgeon and person. I would highly recommend him to anyone considering breast reconstruction and/or cosmetic procedures.

View On Google
Dr. Oren Lerman

Oren Z. Lerman, MD

Dr. Oren Lerman performs a variety of cosmetic and reconstructive procedures with a specialty in reconstructive breast surgery. In fact, he is the director of breast reconstruction at Lenox Hill Hospital's Institute for Comprehensive Breast Care as well as the Microvascular and Cosmetic Breast Fellowship. In addition to the hospital, Dr. Lerman is affiliated with:

  • The New York Regional Society of Plastic Surgeons (Past President)
  • The American Board of Plastic Surgery (Diplomate)
  • The American College of Surgeons (Fellow)
  • The American Society of Plastic Surgeons
  • The American Society of Reconstructive Microsurgery

You can schedule a consultation with Dr. Lerman by filling out our online form or calling (212) 434-6980.

Contact Us Today

"The one thing that is most important when we're doing cosmetic surgery and aesthetic surgery of the face or the body is to make sure that the patient is happy afterwards..." Dr. Oren Lerman

Rate, Review & Explore

Social Accounts Sprite