TRAM Flap Breast Reconstruction

Flap microsurgical breast reconstruction involves the creation of an artificial breast by transplanting tissue from another part of the body. The TRAM (transverse rectus abdominis myocutaneous) muscle flap breast reconstruction technique utilizes a portion of muscle, fat, and skin from the lower abdominal area to form a new breast. TRAM flap surgery can be combined with breast implants to achieve ideal breast size and contour.

TRAM Flap Breast Reconstruction Procedure

TRAM breast reconstruction surgery can be accomplished as a pedicle flap procedure, or a free flap procedure. A pedicle flap procedure simply means that the skin and muscle that is being used to create a new breast is left intact with its natural blood supply. During a free flap procedure, however, the skin and muscle are completely detached from their original blood supply and re-attached at the breast area.

Pedicle Flap Reconstruction

Pedicle TRAM flap breast reconstruction is very popular and is generally a quicker surgery than free flap procedures. In this technique, one side of the abdominal muscle is folded upon itself and pressed through a “tunnel” under the skin that connects to the breast site. This allows most of the blood vessels to remain intact and provide blood to the newly created breast.

Free Flap TRAM Reconstruction

During free flap microsurgical breast reconstruction, the surgeon removes the entire section of abdominal tissue and reattaches it at the site of the new breast. The extracted tissue includes an artery and vein, which are preserved and reattached to blood vessels in the chest area. This ensures that a healthy blood supply reaches the transplanted tissue, making it easier to shape the new breast. This specific procedure uses a relatively small amount of abdominal muscle tissue, therefore abdominal strength is not affected as much as with the pedicle flap technique.

Benefits and Risks of TRAM Flap Breast Reconstruction

There are many factors to take into consideration before undergoing any type of breast reconstruction surgery. Understanding the benefits and risks of TRAM flap breast reconstruction can help you form your decision. Some of the benefits of this procedure include:

• Use of own tissue creates natural-feeling breast
• Pedicle flap procedure maintains as much sensation as possible
• No foreign objects placed in the body
• Long-lasting results
• Renewed sense of femininity

The disadvantages and risks associated with TRAM flap reconstructive surgery include:

• Scarring at two surgical sites
• Increased risk of infection over implant reconstruction
• Decreased abdominal muscle strength (especially with pedicle flap technique)
• Risk of hernias
• Extended recovery time required

TRAM Flap Reconstruction Candidates

After a thorough examination, your surgeon can determine if you are a candidate for TRAM flap reconstruction. Ideal candidates for the procedure include individuals who:

• Have sufficient fat and tissue in the abdominal area
• Do not smoke or suffer from diabetes
• Are at a healthy weight
• Have not had prior abdominal surgery

Many Patients Want to Know …

What if I don’t have enough tissue in my abdomen for the procedure?

If you are a patient who does not wish to receive implant reconstruction, but do not have sufficient abdominal fat to create a new breast, there are still options for reconstructive surgery. Other “free” flap procedures include the gluteal flap and DIEP flap surgeries. These procedures take tissue from different donor sites other than the abdomen, to be used in the creation of a new breast.

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