Tram Flap Breast Reconstruction | Tyler Plastic Surgery | Cosmetic, Plastic and Reconstructive Surgeon

Tram Flap Breast Reconstruction

TRAM flap breast reconstruction is a surgical procedure that many women pursue after undergoing mastectomy, which involves removal of one or both breasts, in order to treat breast cancer. Breast reconstruction procedures, including TRAM flap reconstruction, are the best way for breast cancer survivors who have undergone mastectomy to restore the natural appearance of their chest and reclaim their feminine curves.

TRAM Flap Surgery

About the TRAM flap procedure

Breast reconstruction surgery involving the Transverse Rectus Abdominus Myocutaneous (TRAM) flap procedure is one way to restore natural-looking breasts following mastectomy and successful treatment of breast cancer in one or both breasts without implants. The procedure is quite complex and requires a highly skilled and experienced breast reconstruction surgeon.

Generally, TRAM flap surgery involves a bipedicled, unipedicled or free flap approach. With the bipedicled or unipedicled approach, the skin and fat of donor tissues remain attached to the lower portion of the donor abdominal muscle and are tunneled under the chest wall to reconstruct the new breast. The term bipedicled refers two attachments, whereas unipedicled refers to a single attachment being retained to the abdominal muscle.

With the free flap approach to TRAM breast reconstruction, the skin, fat and muscle tissues moved from the abdominal region to the chest are completely detached from the donor site.

TRAM flap breast reconstruction may be performed under general anesthesia at the same time as mastectomy, but if radiation of the chest is planned, it is best to wait until after the radiation treatment is complete before seeking TRAM flap surgery. A waiting period of 4-6 weeks after completing chemotherapy is also recommended if seeking TRAM flap reconstruction.

Before TRAM flap surgery, you will meet with Dr. Motlagh to discuss your procedure and get pre- and post-operative instructions. Prior to surgery, medical testing, blood donation, routine abdominal exercise and bowel prepartion will likely be necessary.

If only one breast requires mastectomy, breast reconstruction such as TRAM flap surgery may only need to be performed on that breast; however a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.

The TRAM flap procedure is generally the first stage of breast reconstruction, which involves the rebuilding of the breast mound, while additional stages of reconstruction involve revision surgery, as well as areola and nipple reconstruction and cosmetic tattooing. Subsequent stages of reconstruction may be performed under local anesthesia with IV sedation instead of general anesthesia, as is required with the TRAM flap procedure.

TRAM Flap vs. Implants

Comparing TRAM flap surgery with breast implants

TRAM flap breast reconstruction is ideal for patients who have had a mastectomy, wish to restore their upper body contours and would also like excess abodminal tissue and muscle tightening done via abdominoplasty, or tummy tuck.

Patients and surgeons often prefer the breast reconstruction results that can be achieved via TRAM flap surgery versus placement of breast implants or tissue expanders following mastectomy, although this does not mean that TRAM flap surgery is always the most appropriate breast reconstruction procedure. Oftentimes, a flap technique or tissue expander is needed in order for breast implants to be a viable reconstruction option.

Breast implants are generally the best breast reconstruction option for women who:

Are not candidates for or do not want flap surgery
Have had a preventative mastectomy not designed to treat existing breast cancer
Have adequate, uncompromised tissue at the mastectomy site
Desire implants in both breasts, regardless of whether mastectomy was performed on both
Are physically and mentally healthy
Are at a stable body weight

The best candidates for TRAM flap breast reconstruction include women who:

Do not desire or have already tried unsuccessful breast reconstruction with implants
Have adequate abdominal tissue to reconstruct one or both breasts
Have had radiation treatment to the breast or chest area
Are having a skin-sparing mastectomy and want concurrent breast reconstruction
Are pursuing delayed reconstruction after mastectomy
Have not had abdominal surgery in the past, including previous tummy tuck surgery

TRAM Flap vs. Free Flap

Comparing popular flap surgery options

TRAM flap reconstruction differs from free flap reconstruction in that abdominal tissues moved from the donor site to the chest are completely detached from the donor site blood supply and reattached to the blood supply at the site of the breast reconstruction in free flap procedures, whereas with TRAM flap surgery, the main blood vessels that support the donor tissue are tunneled under the skin to the chest and remain attached to donor tissue after it is grafted to the breast reconstruction site.

So, free flap procedures involve extensive microsurgery on the blood vessels, while the TRAM flap procedure typically does not. The only exception to this is when the TRAM flap surgery is performed as a free flap procedure. In this case, the TRAM free flap surgery is almost identical to DIEP free flap surgery, the only difference being that the abdominal muscles are involved in TRAM free flap surgery but not in DIEP free flap surgery.

TRAM flap surgery is generally a better option than free flap surgery for patients who:

Desire and are candidates for concurrent tummy tuck and breast reconstruction procedures
Need or desire to avoid longer operating times required for the more complicated free flap surgery
Want to avoid potential complications surrounding blood vessel reattachment required in free flap surgery
Want to avoid the lengthier hosptialization period needed following free flap surgery

TRAM Flap Recovery

Recovery after TRAM flap reconstruction

After TRAM flap breast reconstruction, patients typically need to be hospitalized for 4-5 days. The initial recovery period after TRAM flap surgery is about two weeks, and during this period patients will have drainage tubes in place.

Usually patients are able to return to an upright position about a week after TRAM flap reconstruction and may begin exercises to re-develop a full range of motion in their shoulders within two weeks of surgery.

Plan on needing at least 6-8 weeks for your body to heal to the point that your energy levels return to normal and regular daily activities can be resumed. About two months after TRAM flap reconstruction, most patients are allowed to resume abdominal exercises.

It will take several months to a year for muscle tightness in the abdomen to resolve and to see the final results of your TRAM flap breast reconstruction procedure. Do not expect sensation to return to your breasts, as this is not a possible outcome of any breast reconstruction procedure.

Although flap reconstruction can rebuild your breasts, the results are highly variable, and it is not uncommon for additional breast reconstruction surgery to be necessary in order to achieve optimal results.

TRAM flap complications

Potential TRAM flap complications include infection, hematoma (bleeding), seroma (fluid collection), abdominal bulging, hernia, fat necrosis and partial or complete loss of flap tissue. Deep venous thrombosis, pulmonary embolism and death are also possible TRAM flap complications, however these are very rare.

If you experience shortness of breath, chest pains or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.

To avoid complications, it is important to refrain from putting pressure on the transferred tissues for at least two months. Additionally, only soft bras should be worn and patients cannot sleep on reconstructed breasts. Heating pads should also be avoided.

It is important to continue routine breast self-examination and have any lumps or masses examined. It is also imperative to follow post-operative care instructions and keep all follow-up appointments with Dr. Motlagh, so he can monitor your recovery.

Tyler Plastic Surgery serves TRAM flap breast reconstruction patients in northeastern Texas, including Tyler, Dallas, Plano and Fort Worth, as well as TRAM flap breast reconstruction patients in Shreveport, Louisiana.

TRAM Flap Breast Reconstruction Terms

Areola: Pigmented skin surrounding the nipple.
Breast augmentation: Also known as augmentation mammaplasty; breast enlargement by surgery.
Breast lift: Also known as mastopexy; surgery to lift the breasts.
Breast reduction: Reduction of breast size and breast lift by surgery.
DIEP flap: Deep Inferior Epigastric perforator flap which takes tissue from the abdomen.
Donor site: An area of your body where the surgeon harvests skin, muscle and fat to reconstruct your breast commonly located in less exposed areas of the body such as the back, abdomen or buttocks.
Flap techniques: Surgical techniques used to reposition your own skin, muscle and fat to reconstruct or cover your breast.
General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
Grafting: A surgical technique to recreate your nipple and areola.
Hematoma: Blood pooling beneath the skin.
Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.
Mastectomy: The removal of the whole breast, typically to rid the body of cancer.
Tissue expansion: A surgical technique to stretch your own healthy tissue and create new skin to provide coverage for a breast implant.
TRAM flap: Also known as transverse rectus abdominus musculocutaneous flap, a surgical technique that uses muscle, fat and skin from your own abdomen to reconstruct the breast.

Tyler Plastic Surgery