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 abdominus muscle in your tummy. There are two ways to do a TRAM flap -- as a free (detatched) tissue flap, and as a pedicle (attached and tunneled) tissue flap. 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.
Recovering from TRAM Flap Breast Reconstruction
Illustration © National Cancer Institute
You may need to stay in the hospital 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 three 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. Notice that this illustration shows a completed TRAM flap with a reconstructed nipple and areola.
TRAM Flap for Double Mastectomy
The TRAM flap can be used for breast reconstruction after, or with, a double mastectomy. You must have enough abdominal tissue for two breasts. Your abdominal skin flap will be divided into two halves, and used to close each mastectomy incision. This double TRAM procedure will take twice as long as a single TRAM, and recovery time will also double. You may feel weak and be in pain for a few weeks afterward.Special Considerations About the TRAM Flap
- One-shot deal – your surgeon can remove abdominal tissue only one time. If you need another breast reconstruction, you'll have to choose a different method.
- Bikini scar – your abdominal scar will be quite long. If you don't wear bikinis anyway, it's no problem. But if you don't want a scar from hip to hip on your tummy, the TRAM is not for you.
- Traveling navel – your belly button may get stretched or moved off-center during a TRAM. Your surgeon may be able to create a new navel for you.
- Looks good, feels OK – your new breast will feel like the real thing to your partner (warm, flexible, soft) but you won't have the same sensations from it as from your original breast. Nerves have been cut, so normal breast sensation will be lost.
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Sources: American Cancer Society. Breast Reconstruction After Mastectomy. Types of Breast Reconstruction. Revised: 09/06/2007. Dr. Susan Love Research Foundation. Breast reconstruction. Updated: April 21, 2008.
There are many types of breast reconstruction - implants, TRAM, Latissimus Dorsi, SGAP, DIEP Flap. What procedure did you have? Would you recommend it to anyone else? What went right or wrong with your reconstruction?
