The most common source of tissue used in breast reconstruction is the abdomen. For years, plastic surgeons have used the Transverse Rectus Abdominis Myocutaneous (TRAM) flap to reconstruct a breast. The TRAM flap, which consists of lower belly skin and fat, can be transferred from the abdomen to the chest to give you a breast mound shape that matches your other natural breast.
The TRAM flap uses one of your rectus muscles to carry the blood vessels that keep the transferred belly skin and fat alive. The whole muscle is required to provide the blood supply for the skin and fat. With the TRAM flap method of breast reconstruction, natural, aesthetic outcomes can be achieved provided your anatomy is appropriate. The end result is a durable reconstruction that does not require implants; a breast reconstruction made only from your own tissues. Although one of your abdominal muscles are used for the reconstruction, studies have shown that your other abdominal muscles can help to mostly compensate within 6 months to 1 year (see scientific reference article below). To determine whether a TRAM flap is the right choice for you, a consultation with Dr. Isik is recommended.
Because your tissues are used and not an implant, long-term problems tend to be minimal to none. The results are often more natural.
Tissue reconstruction is preferred in patients that have had radiation to their chest.
Improved Abdominal Contour
The tissue that is used for the breast reconstruction is the tissue that would have been discarded in an abdominoplasty (tummy-tuck). In most cases, you will have the added benefit of an improved abdominal contour following a TRAM flap for breast reconstruction; however this operation is not a tummy tuck, which will give you a much flatter profile. But too much belly skin and fat is not appropriate for reconstruction and patients that are very obese are not good candidates for the TRAM flap for breast reconstruction.
The TRAM flap is a major surgical procedure requiring 4 to 6 weeks before returning to work or strenuous activities.
Loss of Rectus Muscle(s)
The TRAM flap does weaken the abdomen slightly but studies have shown that most patients are able to return fully to their prior activities once recovered.
Donor Site Scars
There will be a scar on your lower abdomen, from hip to hip and around your belly button and these scars will be permanent.
Patient is shown with a mastectomy scar on her right chest in this pre-operative view.
The abdominal skin and fat tissue remains attached to the rectus muscle, thus preserving its blood supply. The flap, consisting of the skin, fat, and muscle containing the blood supply, are tunneled beneath the skin to the chest, creating the breast mound, usually without need for an implant. This is known as a pedicled TRAM flap.
Final result after TRAM flap shows the scars around the belly button and lower belly, as well as those around the reconstructed breast mound. The scars fade over time to give a final result that is natural and symmetric to your other breast.
Please come in for a consultation to see additional patient photos. Also, we have many patients that have had a TRAM flap breast reconstruction from Dr. Isik who live in Seattle, Eastern Washington, Oregon, Montana and Alaska, that would be happy to share their experience and answer your personal questions. We also have a breast cancer and reconstruction support group that meets once a month in Seattle at The Polyclinic. This is an opportunity to meet and often, see other patients that have had a TRAM, Latissimus, or Implant method of breast reconstruction. Please contact us or download our breast reconstruction brochure to find out more.
Alderman AK, Kuzon WM, Jr., Wilkins EG. A two-year prospective analysis of trunk function in TRAM breast reconstructions. Plast Reconstr Surg, 2006; 117: 2131-2138.