TRAM Flap Procedure

The TRAM flap procedure (Transverse Rectus Abdominus Myocutaneous) is a sophisticated type of breast reconstructive surgery. There are two types of TRAM flap procedures, both of which use skin and fatty issue from the abdominal region to create a natural looking breast. A pedicled TRAM flap procedure will take the fatty issue and skin and move it via tunneling to the chest area. In this procedure the blood supply to the issue is left intact and attached to the body. By contrast, in a free TRAM flap procedure, the tissue is completely detached from the body and moved to the breast area where it is reconnected using microsurgery techniques to the blood supply in the chest.

These procedures are different from a DIEP flap (Deep Inferior Epigastric Perforator) in that it uses muscles from your abdomen in the procedure to create the breast. Both free TRAM and DIEP flaps are microsurgical flaps with distinct advantages over pedicled TRAM flaps and implant based reconstruction in the appropriate situation, and can be an excellent choice of reconstruction for the right candidates

Following a patient evaluation, Dr. Cerio and Dr. Longhmanee, will be able to determine if you are a candidate for these procedures. For selected candidates, it may be the best form of reconstruction available.

One or more of the following may indicate you are a good candidate for breast reconstruction:

  • You are in relatively good physical condition
  • You have undergone, or are planning to undergo, a mastectomy
  • You are bothered by a breast abnormality, a defect, or asymmetry, which makes you feel less feminine
  • You have breasts that are damaged or missing due to a birth defect, injury, radiation, mastectomy or lumpectomy

Dr. Loghmanee or Dr. Cerio will conduct an examination and discuss with you the expected outcome from this procedure and determine how your desires and goals can best be achieved. It is important to note that the look and feel of a reconstructed breast will never be identical to that of a natural breast. You must come prepared to discuss your full medical history, including any medical conditions, previous surgeries or treatments, history of breast cancer and treatment, drug allergies, current medications, and use of alcohol, tobacco or illegal substances.

Considerations with TRAM Flap Procedure:

Cancer Treatment: Ongoing cancer treatments can affect the optimal timing of certain procedures, and can dictate which procedures are performed at which time. It is important to discuss how your cancer treatment will affect your reconstruction. At times, multiple procedures may be necessary for optimal reconstruction outcomes.
Age: Breast reconstruction for breast cancer patients may be performed at any age.
Pregnancy: It is also important to inform Dr. Loghmanee or Dr. Cerio if you are considering having children in the future. Pregnancy can cause bodily changes, which could affect the long-term results of your surgery. Consideration will be given to your specific situation in order to choose the best procedure for your specific goals and lifestyle.

TRAM Flap Surgery and Recovery

Breast reconstruction using one’s own tissue usually requires admission to the hospital for 3-5 days depending on the type of tissue used. 
After breast reconstruction with a TRAM flap, one is usually is able to walk the following day, and will be up and about in the hospital room within the first 24 hours of surgery. There will be drains from the breast and the abdomen that need to be cared for by the nurses, a catheter to drain urine for 24 hours, compression stocking on your legs, and frequent monitoring of the abdominal flap. Your breasts and abdomen will be sore and tender to the touch for the first few days, and you must not lift, bend, pull or push anything, and not engage in any strenuous activity for at least two weeks. More specifically, you will not be allowed to lift anything greater than 5 pounds for at least 4-6 weeks and usually will stay out of work for 2-4 weeks depending on type of occupation. Drain tubes are usually removed after 5-10 days and dressings will be removed within several days and you may be required to wear a supportive garment for comfort and to minimize swelling. Over time, some breast sensation may return. Scarring will improve, but will never fade completely. You should be able to resume your normal activities after 6-8 weeks.
Dr. Loghmanee or Dr. Cerio will recommend follow up visits to closely evaluate your healing process. It is important to follow your doctor’s orders for the best outcome.
Recovery after a flap procedure using you body’s own tissues has a more involved recovery process that will be discussed in detail during your consultation.