What is TRAM Flap Breast Reconstruction?

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  • Written By: Sandra Koehler
  • Edited By: Bronwyn Harris
  • Last Modified Date: 09 October 2019
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TRAM flap breast reconstruction, or transverse rectus abdominus myocutaneous flap breast reconstruction, is a surgical procedure performed after a mastectomy. A mastectomy, the oldest known treatment for breast cancer, involves removal of all or part of the breast. The TRAM flap breast reconstruction is an option to create a new breast.

TRAM flap breast reconstruction is a tissue flap technique which uses the transverse rectus abdominus muscle and the surrounding tissues, blood vessels and fat in your abdomen to form a new breast mound. The transverse rectus abdominus muscle runs the fifth, sixth and seventh ribs to the crest of the pubis bone. The pubis bone is also known as the pelvic bone.

There are two types of TRAM flap breast reconstruction procedures. A pedicle flap involves moving the reconstruction tissues through a tunnel from the abdomen to the chest. A free flap is where the surgeon removes the reconstruction tissues and relocates them to the breast area. This technique involves reattachment of the blood vessels.

Free flap TRAM reconstruction is similar to a DIEP, or deep inferior epigastric perforator flap breast reconstruction procedure. This technique removes only the blood vessels, fat and skin of the abdomen. The transverse rectus abdominus muscle is left intact.


A breast reconstruction performed with the TRAM method results in a natural-looking breast. The new breast will have circulation from the transferred blood vessels, but sensation will be decreased. This happens because the nerves of the original breast have been removed.

The disadvantage to opting for a flap procedure is an increased recovery time when compared to implants. There is also a risk for developing an abdominal bulge or abdominal hernia. An abdominal hernia is when the internal organs of the abdomen bulge or tear through the abdominal wall. This can occur because the musculature of the abdomen has been removed, thus weakening the abdominal cavity. Opting for DIEP reconstruction will minimize the risk of an abdominal bulge or hernia as it leaves the muscle intact.

Other considerations with the TRAM flap breast reconstruction include a hip-to-hip incision line and the possibility of the navel moving or shifting. This can occur because of stretching. However, the surgeon may be able to create a new naval.

The TRAM flap breast reconstruction can be performed during a mastectomy or after treatment is completed. If done during breast removal, however, it may limit radiation treatments sometimes necessary after the procedure to treat any remaining cancer cells. All viable options should be discussed with your physician.


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