Flap Breast Reconstruction: TRAM Technique

During flap microsurgical breast reconstruction performed after a mastectomy, an artificial breast is created by transplanting tissue from another part of the body. The TRAM flap breast reconstruction technique utilizes a portion of muscle, fat, and skin from the abdominal area to form a new breast. TRAM stands for transverse rectus abdominis myocutaneous, the medical name for the muscle and tissue comprising the flap. This technique can be used in combination with breast implants to achieve ideal breast size and contour.

TRAM Flap Breast Reconstruction after Mastectomy

TRAM breast reconstruction surgery can be accomplished in two ways. The first method of TRAM flap breast reconstruction surgery keeps the flap of skin attached to its original blood vessels (pedicle flap). The second method transplants skin to the breast and microsurgically reattaches the blood vessels to existing ones in the chest area (free flap).

Pedicle Flap: Tunneling Breast Reconstruction

Pedicle flap breast reconstruction is very popular and generally quicker to perform than microsurgical breast reconstruction. In this technique, one side of the abdominal muscle is folded upon itself and passed 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.

This technique does not require training in microsurgery, and is therefore more widely performed. However, the pedicle flap breast reconstruction method does have drawbacks, including the risk of significantly decreased abdominal strength, fat necrosis (the death of fat tissue in the breast due to inadequate blood supply), and abdominal hernias.

Free Flap: Microsurgical Breast 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 method insures that a healthy blood supply reaches the transplanted tissue, making it easier to shape the new breast. A surgeon must have experience in microvascular surgery and microsurgical techniques to perform the free flap breast reconstruction procedure.

Because this technique uses a relatively small amount of abdominal muscle tissue, the patient’s abdominal strength is not affected as much as it is with the pedicle flap technique. Another advantage of free flap microsurgical breast reconstruction is decreased pain after surgery.

Considerations for TRAM Flap Patients

Patients considering TRAM flap breast reconstruction after a mastectomy may want to consider some of the ways in which the procedure differs from breast reconstruction with implants. One point to note is that the additional surgery required to extract tissue from the donor site leaves further scarring and lengthens the patient’s recovery time. Another consideration is the fact that TRAM flap breast reconstruction can only be performed once. This means that if the remaining natural breast must be removed at some point in the future, an alternative reconstruction technique will need to be used.

One of the advantages of TRAM and all flap breast reconstruction techniques is that they do not involve the insertion of foreign materials into the body. This eliminates some of the risks of breast reconstruction with implants, which include the formation of scar tissue at the implant site.

Locate a Plastic Surgeon near You

An experienced cosmetic surgeon can help you understand the details of TRAM flap breast reconstruction after a mastectomy, including pedicle flap and microsurgical (free flap) breast reconstruction. Use the DocShop directory of qualified medical professionals to find a doctor in your area.