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Transverse rectus abdominis myocutaneous (TRAM) flap is a highly effective and commonly performed procedure for breast reconstruction following mastectomy. This surgical technique involves the transfer of tissue, including skin, fat, and the underlying rectus abdominis muscle, from the lower abdomen to the chest area to recreate a natural-looking breast. The amount of tissue that is taken from the lower abdomen will depend on the size of the breast that you want to reconstruct.
Hand and Upper Extremity Surgery
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Conditions Treated
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Procedure Time
6-12 Hours
Treatment Location
In-Clinic
Sedation
General Anesthesia
Recovery Time
3 to 6+ Months
What to Expect
During TRAM flap reconstructive surgery, tissue will carefully be removed from the lower abdomen while preserving its blood supply. This tissue, along with the underlying rectus abdominis muscle, will be relocated to the chest area to create a natural-looking breast. There are two main techniques used for TRAM flap reconstruction:
- Pedicled TRAM Flap Reconstruction
In this technique, the tissue from the lower abdomen is tunneled under the skin to the breast area. The blood supply to the tissue is maintained by the blood vessels that connect the rectus abdominis muscle to the chest wall. This allows the tissue to remain attached to its original blood supply. - Free TRAM Flap Reconstruction
In this approach, the tissue from the lower abdomen is completely separated from its blood supply and then reattached to blood vessels in the chest. Microsurgery, which involves using a microscope to make small incisions and stitches, is utilized for this delicate procedure. The reattachment of blood vessels ensures proper blood circulation in the chest area.
Both pedicled and free TRAM flap procedures have their advantages and considerations, which will be evaluated by your surgeon to determine the most suitable technique for your specific case.
After the Procedure
After undergoing TRAM flap surgery, it is important to understand what to expect during the recovery process. Here is a comprehensive overview of the post-operative phase:
- Incisions and Drains
You will have two incisions, one in your lower abdomen and one in your breast. The incision in the lower abdomen will typically be 6-8 inches long, while the incision in the breast will be about 3-4 inches long. These incisions are carefully closed with sutures. Drains will also be placed in the surgical site to remove excess fluid and will be removed after a few days. - Compression Garment
To support your abdominal muscles and minimize swelling, you will be required to wear a compression garment on your abdomen for several weeks following the surgery. This garment helps to reduce discomfort and promote proper healing. - Post-operative Care Instructions
Your surgical team will provide detailed instructions on wound care, including how to clean and care for your incisions. They will also guide you on activity restrictions and gradually reintroducing normal daily activities. To ensure a smooth recovery, you must follow these instructions diligently. - Follow-up Appointments
Regular follow-up appointments will be scheduled to monitor your healing progress. During these appointments, your surgeon will assess the condition of your incisions, remove any remaining sutures, and address any concerns or questions you may have. These appointments are crucial for achieving the best results and ensuring a successful recovery.
While the recovery process can vary from person to person, it generally takes several weeks to resume normal activities. It is important to be patient and give yourself ample time to heal properly. During this period, you must avoid strenuous activities, heavy lifting, and exercises that strain the abdominal muscles. It is important to follow your surgeon’s post-operative instructions diligently, attend scheduled follow-up appointments, and report any unusual symptoms or concerns promptly.
Need guidance about TRAM flap breast reconstruction?
Choosing the right breast reconstruction procedure is an important decision, and we are here to guide you every step of the way. Our goal is to ensure your safety, comfort, and satisfaction throughout your surgical journey. Request an appointment today with one of our topnotch reconstructive surgeons to learn more about TRAM flap reconstruction, understand its benefits and potential risks, and make an informed choice about breast reconstruction.
Risks & Side Effects
Majority of patients who undergo TRAM flap reconstruction experience successful outcomes without significant complications. But as with any surgery, it is vital to be informed about the potential risks involved. Our surgeons will thoroughly discuss these risks with you during the consultation and address any concerns or questions you may have. These risks generally include:
- Infection
Although uncommon, there is a risk of infection following TRAM flap reconstruction. Antibiotics are typically administered to minimize this risk, and proper post-operative care is crucial to prevent infection. - Bleeding
While steps are taken during surgery to control bleeding, there is a possibility of bleeding at the surgical site. This risk is usually managed effectively during the procedure, and any excessive bleeding can be addressed promptly. - Tissue Necrosis
Tissue necrosis refers to the death of tissue in the reconstructed breast or donor area. It can occur due to compromised blood supply to the tissue. Although rare, it is a potential complication that our surgeons will monitor closely and manage appropriately if it occurs. - Abdominal Weakness and Hernia Formation
During TRAM flap reconstruction, the rectus abdominis muscle is utilized. As a result, there is a risk of abdominal weakness and the formation of a hernia. Proper post-operative care and adherence to activity restrictions are essential to minimize these risks. - Changes in Abdominal Sensation
The surgical procedure may affect the nerves in the lower abdomen, leading to changes in abdominal sensation. This can result in temporary or permanent alterations in sensation, such as numbness or increased sensitivity.
It is important to remember that the TRAM flap surgery is generally a safe and commonly performed procedure. Knowing the potential complications and what can be done to avert and address them is essential to minimize risks.
Am I a candidate for TRAM Flap Surgery?
During your consultation with one of our breast reconstruction surgeons, your medical history, surgical goals, and expectations will be thoroughly assessed. A physical examination will also be performed to determine if you are a suitable candidate for this procedure. Generally, to be a suitable candidate for TRAM flap reconstruction, you must meet the following criteria:
If you've had a mastectomy and are exploring breast reconstruction options, TRAM flap reconstruction could be a great fit for you. Our skilled reconstructive surgeons will carefully assess your unique situation, talk about your goals, and conduct a thorough evaluation to determine if TRAM flap reconstruction is the ideal choice for you. It's time to embrace a new chapter of wellness and confidence. Don't hesitate—schedule an appointment with our topnotch surgeons today.
- You have undergone mastectomy or need breast reconstruction after lumpectomy.
- You have an adequate amount of abdominal tissue available for the transfer.
- You are in overall good health to undergo a surgical procedure.
- You have realistic expectations and a positive disposition towards the reconstruction process.
If you've had a mastectomy and are exploring breast reconstruction options, TRAM flap reconstruction could be a great fit for you. Our skilled reconstructive surgeons will carefully assess your unique situation, talk about your goals, and conduct a thorough evaluation to determine if TRAM flap reconstruction is the ideal choice for you. It's time to embrace a new chapter of wellness and confidence. Don't hesitate—schedule an appointment with our topnotch surgeons today.
Find a Breast Cancer Surgeon in New Jersey
When it comes to undergoing a complex procedure like TRAM flap breast reconstruction, it's crucial to find skilled and experienced surgeons who specialize in this technique. We understand the importance of convenience and accessibility, which is why we have a team of highly trained surgeons located near you.