What is a TRAM Flap? – Orange County | Newport
The most common procedure for autogenous tissue reconstruction is the pedicled transverse rectus abdominus myocutaneous (TRAM) flap. In this approach, Dr. Seify uses the entire rectus abdominus muscle to pull the lower abdominal skin and fat up to the chest wall. He then creates a breast shape using this tissue. To transfer the flap up to the chest, the muscle is tunneled beneath the upper abdominal skin. Because the patient’s own body tissue is used, the result is a very natural breast reconstruction. Also many patients benefit from a flatter looking abdomen. The incision and scar on the abdomen is low and will extend from hip to hip. The tram flap can be utilized for reconstruction of breast either bilaterally or unilaterally. When patients are having unilateral reconstruction, the Tram flap can possibly offer a more aesthetically pleasing result and better symmetry thin utilizing an implant.
The Tram flap is possible because of the superior epigastric vessels, which are considered to be secondary blood supply for the lower abdominal wall skin. Some patients are not candidates for this type of reconstruction due to the fact that there are limitations in the flap blood supply. For example smokers, diabetics, and patients who are obese are generally considered to have relative contraindications to having a pedicled TRAM flap breast reconstruction.
The primary advantage to the Tram flap is the natural looking and feeling breast, the main disadvantages are related to the abdominal wall donor site. These include are not limited to abdominal wall weakness, bulging, and hernia. To minimize the development of a hernia, Dr. Seify may use a synthetic mesh when creating closure of the abdomen.
The Tram flap surgery is much more invasive than implant reconstruction. The surgery will typically take Dr. Seify approximately 4 to 5 hours. For bilateral reconstruction, it could be approximately 5 to 7 hours. The hospital stay is typically 3 to 5 days. Patients will experience abdominal pain and tightness for several weeks and it could take several months to return to the full range of activities.
Secondary procedures following tram flap reconstruction can be performed in approximately 3 months. However, if chemotherapy is indicated, additional surgery must be postponed until the completion of treatment. Once the patient has been medically cleared they can have revisions to the breast and abdomen performed and the nipple areola can be created. These procedures are typically performed on an outpatient basis and have rapid recovery.
Ideal candidate for TRAM flap reconstruction include Bruno not limited to:
- patients who desire autogeneous reconstruction
- patients who do not want or are not a candidate for implant reconstruction
- patients who have substantial lower abdominal wall tissue to create one or both breasts
- patients who have not had prior abdominal surgery
- patients who previously had chest wall radiation
- patients who have experienced failed implant reconstruction
- patients who are having immediate reconstruction during skin-sparing mastectomy
- patients who are having delayed reconstruction after prior mastectomy
Patients are not ideal candidates for TRAM flap reconstruction if:
- patients do not have enough lower abdominal tissue to create the flaps
- patients have a large overhanging pannus of abdominal skin and fat
- patients have a BMI of 30 or above
- patients have diabetes
- patients who are a smoker sor quit smoking only recently
- patients have had previous abdominal surgeries such as abdominoplasty
- patients who cannot tolerate anesthesia for long periods
- patients who do not want to have a lower abdominal scar