TRAM Flap ReconstructionDuring a TRAM flap reconstruction, skin, fat, and muscle will be moved from your tummy up to your chest, and used to create a breast mound. Most women have enough tissue in their tummy area to create a new breast. But if there is not enough tissue, a small implant can be placed to fill out the size of the new breast. Two methods are used to move your tissue from your tummy to your chest -- free flap and pedicle flap.
Free and Pedicle Flap Methods
- Pedicle Flap – This method does not require cutting the flap of skin, fat, blood vessels, and muscle free from it's location in your abdomen. A pedicle flap will be moved through a tunnel under your skin up to your chest area.
- Free Flap – Your surgeon will cut a section of skin, fat, blood vessels, and muscle free from it's location in your abdomen. This section will be relocated in your chest area and reconnected to your blood supply using microsurgery (similar to a DIEP flap procedure). This will take more time than a pedicle flap procedure, but many surgeons feel that it creates a more natural breast shape.
Advantages of the TRAM FlapA TRAM flap reconstructed breast will feel very much like a natural breast to anyone who is touching you: It will be warm and soft because it will have good circulation and enough fat to drape and sway like your original breast. Because abdominal muscles and fat are incorporated into your new breast, you will also have a tummy tuck, resulting in a flatter abdomen.
Disadvantages of the TRAM FlapYour new breast will not have much sensation, because the nerves that were in your original breast have been removed. A TRAM flap procedure requires more time in surgery and recovery than implant placement. Some risks are associated with a TRAM flap -- abdominal hernia and abdominal bulge (because muscle that supports the abdomen has been moved). The TRAM flap procedure has a 5% failure rate in which case the flap may die, and will have to be completely removed. A pedicle flap, which is never disconnected from its blood supply, is much less likely to fail.
You're Not a Candidate If:
- you are overweight or obese - you are at greater risk for an abdominal hernia after a TRAM, since there is less muscle to support your tummy weight
- you are quite thin – you won't have enough abdominal tissue
- you smoke – your abdominal scar will take a long time to heal, and your fat tissue is more apt to develop into scar tissue
Breast Reconstruction Now or LaterBreast reconstruction can be done during a mastectomy or after treatment. If you need radiation therapy to the underarm area or chest, you should delay. However, it is worth waiting: Having the procedure done before treatment is complete severely limits a radiation therapist's ability to properly treat you.
If you are thinking about reconstruction, it's a good idea to talk with your plastic surgeon before having a mastectomy. This gives you the chance to have measurements and pictures taken of your natural breasts, so your reconstructed breast can be recreated as accurately as possible. Your plastic surgeon will offer you a range of options, and can help save skin and prevent unnecessary scars, if you consult with him beforehand.