TRAM Flap Breast Reconstruction Surgeon | Breast Reconstruction Surgery | Breast Enhancement | Breast Augmentation

Seattle and Bellevue Washington

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, fat and one or both rectus muscle(s), 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 the rectus muscle to carry the blood vessels that keep the transferred overlying 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.

A rectus muscle-preserving variant of the TRAM flap is the DIEP (Deep Inferior Epigastric Perforator) flap, which only removes the skin and fat from the abdomen and leaves the rectus muscles intact. This technique is more complex and consequently requires longer surgical time, but can achieve excellent aesthetic results without cutting any of your muscles. Because the rectus muscles are spared, recovery time is often shorter and patients are often able to resume activities at a more strenuous level than patients who had their rectus muscles used for the reconstruction. However, not everyone has the appropriate anatomy for a DIEP free flap and a consultation with Dr. Isik is recommended.

TRAM Advantages

Your Tissues
Because your tissues are used and not an implant, long-term problems tend to be less. The results are often more natural.

Durable Reconstruction
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 or, a DIEP flap for breast reconstruction. But too much excess skin and fat is not appropriate for reconstruction and patients that are very obese are not good candidates for either the TRAM flap or DIEP flap for breast reconstruction.

TRAM Disadvantages

Major Surgery
The TRAM flap, whether done as a pedicled flap or a microsurgical free flap, is a major surgical procedure requiring 4 to 6 weeks before returning to work and more strenuous activities.

Loss of Rectus Muscle(s)
This results in increased pain but only for the immediate recovery period. The TRAM flap does weaken the abdomen slightly but most patients are able to return 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. These are the same scars as from a DIEP flap and similar to those after a tummy-tuck.

after mastectomy TRAM flap before
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.

TRAM Flap for breast reconstruction 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.

Download our information brochure on breast reconstruction.
You will need Adobe Acrobat Reader to open it. You can also visit our Commonly Asked Questions page on breast reconstruction to learn more.

Actual patient photos are not shown on this web site. However, you can download our brochure, or come in for a consultation to see actual 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 DIEP, TRAM, Latissimus, or Implant method of breast reconstruction. Please contact us to find out more.