American Society of Plastic Surgeons
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What is the TRAM flap breast reconstruction technique?

TRAM flap breast reconstruction

Plastic surgery can accomplish a great deal, but some of the most important work that a plastic surgeon can do is helping women regain a sense of normalcy and wholeness after undergoing a mastectomy for the treatment of breast cancer.

Although the inspiring women who struggle against and overcome breast cancer are all on a similar journey, no two are ever on exactly the same path, which is one of the reasons why there are so many different approaches to breast reconstruction surgery. Some utilize silicone or saline breast implants, like those used during breast augmentation, while others rely on the manipulation of the patient's own tissue. While each approach has distinct advantages that allow it to be customized to the needs of the individual patient, one of the most effective and versatile of the autologous tissue breast reconstruction methods is still the classic TRAM flap breast reconstruction technique.

Originally developed in the 1980's by Dr. Carl R. Hartrampf, a TRAM flap procedure involves moving a small amount of the patient's abdominal tissue, including fat and muscle, to the chest, where it can then be used to rebuild the breast mound. The technique takes its name from the portion of the Transverse Rectus Abdominis Myocutaneous (or TRAM) muscle that is used to give the attached tissue and fat an adequate blood supply.

Techniques for TRAM flap breast reconstruction

There are two distinct approaches to a TRAM flap procedure: a "pedicled" TRAM, where the muscle and tissue are left attached to their original blood supply in the abdomen and are maneuvered underneath the skin to their new location in the chest, and a free TRAM, where those tissues are completely detached and then reattached to the blood vessels in the armpit area using advanced microsurgical techniques.

Each technique has different advantages and disadvantages. A pedicled TRAM is usually a less intricate procedure, requiring less time in surgery. Conversely, a "muscle-sparing" free TRAM flap uses a smaller portion of the rectus muscle, so women tend to recover more quickly and have a lower risk of losing abdominal muscle strength. In either case, a TRAM flap breast reconstruction uses natural tissue taken from the patient's own body, rather than artificial silicone breast implants, and can provide the benefits of an abdominoplasty, or tummy tuck, in addition to natural-looking breast reconstruction results.

Candidates for TRAM flap breast reconstruction

Ideal candidates for a TRAM flap breast reconstruction are women who have undergone a single or double mastectomy for the treatment of breast cancer and who have enough fat and tissue in the abdominal area to support the procedure. Additionally, as with all forms of surgery, patients should have no medical conditions, other illnesses or habits (such as smoking) which might impede the healing process, and should also have a thorough understanding of what the procedure will entail as well as reasonable expectations about its outcome. Individual patients will heal at different rates, so recovery times can vary, however, patients should expect to experience some soreness and swelling in the affected areas for several weeks before full mobility is restored. Some women may experience a change in breast sensation after breast reconstruction surgery, and some scarring at the incision sites will occur. However, the latter can be minimized through the use of advanced surgical techniques and both side effects will generally fade gradually over time.

The best results are achieved when the procedure can be customized to the specific needs and body type of the patient, so your surgeon will give you detailed personalized instructions regarding medications, bandages and dressings, follow-up care and when you can return to normal, physical activity. Finally, the cost of a TRAM flap breast reconstruction will often vary depending on the surgeon's experience and geographic location, but breast reconstruction surgery after breast cancer is considered a reconstructive procedure and should be covered by most health insurance plans. It is important to note, however, that an individual patient's coverage may only provide a portion of the total fee.

Is TRAM flap breast reconstruction right for you?

Women have a wide variety of options in breast reconstruction, and a TRAM flap approach, although highly effective, is not necessarily the best choice for all patients. During a full breast reconstruction consultation, you'll have the opportunity to discuss your specific aesthetic goals and personal health concerns with your plastic surgeon, so that you can work together to find an approach that will give you the best possible results. Ultimately, breast reconstruction can lessen the physical and emotional impact of mastectomy and help patients feel as though they are finally taking back control of their lives.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.


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