TRAM flap breast reconstruction uses tissue from the abdomen to create a new breast after a mastectomy. There are two types of procedures, with the free flap being similar to DIEP reconstruction. Recovery time is longer than with implants and there is a risk of abdominal hernia.
TRAM flap breast reconstruction, or rectus abdominis myocutaneous flap breast reconstruction, is a surgical procedure performed after a mastectomy. A mastectomy, the oldest known treatment for breast cancer, involves the removal of all or part of the breast. TRAM flap breast reconstruction is one option for creating a new breast.
TRAM flap breast reconstruction is a tissue flap technique that uses the rectus abdominis muscle and surrounding tissues, blood vessels, and fat in the abdomen to form a new breast mound. The rectus abdominus muscle runs the fifth, sixth, and seventh ribs to the crest of the pubic bone. The pubic bone is also known as the pelvic bone.
There are two types of TRAM flap breast reconstruction procedures. A pedicle flap involves moving the reconstruction tissues through a tunnel from the abdomen to the chest. A free flap is where the surgeon removes the reconstruction tissues and transfers them to the breast area. This technique involves reattaching blood vessels.
Free flap TRAM reconstruction is similar to a DIEP, or deep inferior epigastric perforating flap breast reconstruction procedure. This technique only removes blood vessels, fat and skin from the abdomen. The transverse rectus abdominis muscle is left intact.
A breast reconstruction performed with the TRAM method results in natural looking breasts. The new breast will have circulation from the relocated blood vessels, but sensation will be diminished. This happens because the original sinus nerves have been removed.
The disadvantage of opting for a flap procedure is a longer recovery time compared to implants. There is also the risk of developing an abdominal bulge or an abdominal hernia. An abdominal hernia is when the internal organs in the abdomen swell or tear the abdominal wall. This can occur because the musculature of the abdomen has been removed, thus weakening the abdominal cavity. Opting for DIEP reconstruction will minimize the risk of an abdominal bulge or hernia as it leaves the muscle intact.
Other considerations with TRAM flap breast reconstruction include a hip-to-hip incision line and the possibility of the belly button moving or dislodging. This can occur due to stretching. However, your surgeon may be able to create a new belly button.
Breast reconstruction with the TRAM flap can be performed during a mastectomy or after completion of treatment. If performed during breast removal, however, it can limit the radiation treatments sometimes needed after the procedure to treat any remaining cancer cells. All viable options should be discussed with your doctor.
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