TRAM Flap

The TRAM flap consists of the skin and fat from the lower abdomen and a portion of the Transverse Rectus Abdominis Muscle. This muscle is also known as the "six pack" muscle of the abdomen. Because this muscle carries the blood supply to the skin and fat of the lower abdomen this is commonly used to reconstruct a breast mound. Traditionally this procedure was performed by flipping the muscle up to the removed breast site without disconnecting the blood supply.

Today this procedure is most often performed as a muscle sparing free TRAM flap. This means that instead of taking the whole muscle and flipping it up, the skin and fat is removed from the lower abdomen (like a tummy tuck procedure), with a small amount of muscle, hence "muscle sparing". This makes the reconstructed breast mound easier to mold into a breast and gives it more reliable blood supply which can be used in most patients who desire this reconstruction. The blood vessels (which happen to be the same ones used in the DIEP flap) are then microsurgically reattached to vessels in your chest to give you a new breast mound.

The advantage to using the lower abdominal tissue for surgery is that women get a flatter midsection, like a "tummy tuck". In cases where women have excess lower abdominal tissue, this is a very good operation, because the reconstructed breast mound is natural feeling and projecting, and ages with you despite your body type. Sensation will never be normal as your breast has been removed, but the flap will gain protective (temperature and pain) sensation over time. Because the muscle sparing free TRAM is made of your own tissue, it is a very natural type of reconstruction. In the long run the outcomes from this operation for breast reconstruction are more natural than those obtained by implants alone.

It is important to note that tissue can be taken from your abdomen only once. If you ever need a second breast reconstruction, the tissue used will come from a different site.