TRAM Flap Breast Reconstruction

Used in breast reconstruction, the TRAM (Transverse Rectus Abdominus Myocutaneous) flap is a procedure that involves transferring tissues from the abdomen to the breasts without the use of implants. Like other flaps, the TRAM flap can be done as either a pedicle or free flap procedure.

In the pedicle procedure, skin and fat are left attached to the lower portion of one rectus abdominus muscle, and are tunneled under the chest wall to reconstruct the new breast. For the free flap, a portion is divided from the abdomen above and below the attached skin and fat. The skin tissue is removed with its attached blood vessels, transferred to the chest, and the blood vessels are reattached to provide blood flow to the transferred flap.

Indications for the TRAM flap

Any patient who is undergoing or has already received a mastectomy may be a candidate for a TRAM flap procedure. Other qualifications include but are not limited to the following:Thinking about breast reconstruction after mastectomy?
  • History of radiation to the chest wall
  • Large opposite breast (difficult to match with an implant)
  • Small opposite breast (difficult to match with an implant)
  • Previous failure of implant reconstruction
  • Excess lower abdominal tissue and patient desires abdominoplasty
Indications for the two approaches to the TRAM flap are as follows:

Pedicle TRAM:
  • No sufficient recipient vessels for a free flap reconstruction
Free TRAM:
  • Desire to maximize or preserve abdominal muscle function
  • Division of the superior epigastric blood supply by previous surgery

How is it done?

Breast reconstruction using flaps is a major surgery conducted in a hospital setting with general anesthesia. The patient may be encouraged to perform abdominal exercises to strengthen muscle and to improve blood supply in the weeks leading up to surgery.

On the day of surgery, the incision sites are marked and the anesthesia is administered. The entire rectus muscle may be included in the flap, or the muscle may be split. Once the muscle is divided, the flap is tunneled to the chest. Liposuction to the abdomen may be added in order to improve the aesthetic results. The surgeon then uses the flap to shape the breast mound, taking care to match it with the opposite breast. In most cases the umbilicus will need to be relocated.

During a TRAM free flap procedure, no tunnel is necessary to the mastectomy site, as the tissue is completely removed and replanted at the donor site.

After the breast mound is completed, the surgeon will close the incisions with sutures.

Post-operative care

You should expect to spend the first days after surgery in the hospital so that qualified professionals can supervise your recovery process. The drains inserted during surgery to remove excess fluid are removed after 1-2 weeks. It will take between six weeks to two months before you regain your energy and can resume normal activities. Please consult with your surgeon to receive more detailed instructions on aftercare, as well as a recommendation for follow-up visits and breast examinations.

Surgeons Korentager, Ponnuru, Hendrix, De Souza, and Bhavsar are eager to take your questions about TRAM flap breast reconstruction. Feel free to contact us at 913-588-2000 if you would like to receive more information about the costs, risks and benefits of breast reconstruction surgery.

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