The evolution of using one’s abdominal skin and fat for breast reconstruction

A few decades ago, using one’s own abdominal/tummy skin and fat for breast reconstruction was first described using a TRAM flap (transverse rectus myocutaneous flap) which involved the entire 6-pack muscle on one side (typically) being moved to the chest area for a one sided breast reconstruction.  Over time, using own’s own fat/skin has evolved into less and less muscle being used, and in the process attempting to decrease the bulge and hernia rate that potentially could occur at the abdominal area.  These procedures have been described as muscle-sparing TRAM flaps for instance.  A DIEP flap (deep inferior epigastric perforator flap) aims to use only the blood vessels that supply the fat and skin without transferring muscle.