What is TRAM Flap Breast Reconstruction?
The TRAM flap (Transverse Rectus Abdominus Myocutaneous) is a tissue flap procedure that uses muscle, fat, and skin from your abdomen to create a new breast mound after a mastectomy.
This procedure takes its name from the transverse rectus abdominis muscle in your tummy. Your reconstructed breast will not look and feel exactly the same as your natural breast, and you will need additional surgery to create a nipple and areola.
During a TRAM flap reconstruction, skin, fat, and muscle will be moved from your tummy up to your chest and used to create a breast mound. Most women have enough tissue in their tummy area to create a new breast. But if there is not enough tissue, a small implant can be placed to fill out the size of the new breast. Two methods are used to move your tissue from your tummy to your chest — free flap and pedicle flap.
A TRAM flap reconstructed breast will feel very much like a natural breast to anyone who is touching you: It will be warm and soft because it will have good circulation and enough fat to drape and sway like your original breast. Because abdominal muscles and fat are incorporated into your new breast, you will also have a tummy tuck, resulting in a flatter abdomen. It is important to know that your new breast will not have much sensation, because the nerves that were in your original breast have been removed.
You will not be awake during your mastectomy or reconstruction, so you will have intravenous sedation or general anesthesia. If you are having a mastectomy and reconstruction at the same time (immediate reconstruction), your general surgeon will first remove your breast, sparing as much skin as will be safe to keep. Then, Dr. Birely will use a skin marker to carefully plan for the incision that will create your skin flap. A pointed ellipse will be drawn across your abdomen, over your rectus abdominis muscle. This ellipse will become the skin flap that closes the incision for your reconstructed breast. When the incision for the flap is shut, it will become a line that crosses your tummy from hip to hip. On the skin markings, Dr. Birely will make an incision, and raise the skin and muscle flap. A tunnel will be created under your skin so that the flap can be relocated. This tissue flap will go through the tunnel to your mastectomy incision.
You may need to stay in the hospital for 4 to 7 days as you begin healing from breast reconstructive surgery. If you have surgical drains, you will learn how to empty those and keep records of the fluid volume. Report pain if you have any so that it can be treated.
Don’t go right back to work; plan on taking it easy for 3 to 6 weeks for recovery. Be sure to have someone around to help drive you and do any lifting. Also, be sure to go for your follow-up appointments so your surgeon can keep an eye on your incisions and dressings, and remove your drains.
Dr. Brent Birely is a board-certified plastic surgeon with offices in Lutherville and Bel Air, serving patients from Baltimore, Towson, Columbia, Westminster, and other Maryland cities. He is a very well regarded leader in cosmetic surgery and patient safety, and specializes in procedures including breast augmentation, tummy tuck, mommy makeover, facelift, and body lifting procedures after weight loss.
*The content/images on this website are not a guarantee of individual results. Individual results may vary. The information provided on this site is for general informational purposes only and does not replace the need for a formal consultation with a plastic and reconstructive surgeon before undergoing a surgical procedure or skin care treatment.