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Performing breast reconstruction with the Free TRAM, DIEP, SIEA, or Gluteal Flap requires the use of microsurgery. When using these microsurgical techniques, the tissue from your abdomen or buttock is disconnected from its original blood supply and reconnected to a new blood supply in the breast region. This requires use of a microscope and sutures finer than a human hair.

After surgery, careful monitoring is required to ensure that your blood vessels do not clot. Clotting of the vessels may happen (approximately two to five percent of the time) and necessitates an immediate return to the operating room to remove the clot. In most instances, the clot can be removed and the circulation restored. In a small number of cases (less than one percent) circulation cannot be restored and the flap is completely lost, thereby necessitating a different method of reconstruction that would be done at a later time.

Overall, microsurgery is successful about 97 to 98% of the time.