TRAM stands for Transverse Rectus Abdominus Myocutaneous flap. With this technique, your excess abdominal skin and fat is used to reconstruct the missing breast. The TRAM can be performed immediately or as a delayed reconstruction. There are three basic types of TRAM flaps:
- Pedicled TRAM
- Free Tram
- DIEP or SIEA Flaps
The TRAM, DIEP, and SIEA flaps can be used for reconstruction of both breasts simultaneously. However, once they have been used to reconstruct a single breast they cannot be used again in the future for the other breast.
Could this procedure be right for you?
- If you have loss of breast tissue and skin following mastectomy on one or both sides.
Intended Results
- Reconstruction of a missing breast(s) or replacement of breast tissue.
Procedure
A flap of your lower abdominal fat, muscle (and usually skin), is transferred to the area of missing breast tissue with its own blood supply. In a standard TRAM flap, the blood supply is within the rectus muscle(s), which is left attached to the lower edge of the rib cage.
- In a free TRAM, the blood vessels are reconnected to the vessels in the axilla.
- In a Turbocharged TRAM, the muscle is left attached superiorly, but the inferior vessels are connected in the axilla creating a double blood supply.
- The abdominal donor site is closed as in a tummy tuck, leaving a horizontal scar and a tighter abdomen.
- An attempt is made to create a "normal" breast mound and shape at the first operation, but subsequent smaller procedures are frequently necessary.
- Nipple/areolar reconstruction is performed at a later date.
Recuperation and Healing
- A TRAM Flap Breast Reconstruction is a major procedure performed in the hospital and requiring at least several days of hospitalization.
- You will start walking the day after surgery and will be reasonably comfortable within ten to fourteen days.
- Complete recovery usually takes about 6 weeks.
- The abdominal area causes the most discomfort during healing.
Other Options
Additional procedures that may enhance your results are enlargement, lifting, or reduction of the opposite breast, and nipple/areolar reconstruction.
Take Note of These Important Insurance Guidelines
This procedure is usually covered by insurance. You must check with your own insurance company to determine your specific coverage and exclusions.