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Transverse Rectus Abdominis Myocutaneous
(TRAM) flap is the most common autologous procedure for breast
reconstruction. Autologous means using the patient’s own tissue for
reconstruction. This avoids the use of prosthetic (implant) material. The
main advantage of this procedure is that the lower abdominal tissue is used
for the breast reconstruction and not an implant. The “new” breast has a
more natural feel and look compared to am implant redconstruction. The
abdomen is closed by pulling the remaining skin tight which creates a flat
and more attractive abdomen similar to a tummy tuck procedure.
The main disadvantage of a traditional TRAM procedure is that one or
both rectus muscles (six-pack muscles) have to be sacrificed. Therefore the
abdominal wall will be weaker. This has been the main reason why DIEP and
muscle sparing free TRAM flap procedures have been developed and have
gained in popularity over the recent years. For further information on
those procedures, please click on
DIEP.
Ideal Candidates:
Ideal candidate should not have any severe medical conditions such
cardiac disease, pulmonary disease, or clotting abnormalities. The ideal
patient has moderate degree of lower abdominal skin and fat laxity to allow
for harvest of adequate volume of tissue for breast reconstruction.
Patients who have had previous abdominal surgeries including tummy tuck and
liposuction may not be a candidate for this type of reconstruction. Please
review your previous surgeries with Dr. Soltanian during your consultation.
Preoperative visit:
During the first visit, pertinent data regarding the cancer history,
cancer treatments, past medical and surgical history are collected. After
the physical examination, Dr. Soltanian will provide you with an overview
of breast reconstruction options for you. He will review anatomic
illustrations, and before and after pictures with you. It is not uncommon
to have more than one consultation before finalizing the decision for the
TRAM flap procedure. We encourage the patients to review the information at
home and record their questions for the second preoperative visit. Quite
often it is helpful to discuss the issues with close family members and
friends. You will have ample time to ask your questions and discuss your
concerns with Dr. Soltanian. Upon request, our previous patients are
available to share their experience with you.
Operative Procedure:
An elliptic portion of the abdominal skin and fatty tissue is separated
from the surrounding tissue and left attached to the rectus muscle. The
muscle is transected at the level below the skin flap. The entire flap
(skin, fatty tissue, and muscle) is separated from the rest of the
abdominal wall and tunneled into the defect from mastectomy. The muscle is
left attached on its upper end to allow for blood to reach the rest of the
flap. The flap is attached to the surrounding skin and tissue on the chest
to form a new breast mound. The abdomen is closed similar to a tummy tuck
procedure. Occasionally, a synthetic mesh is used to reinforce the
abdominal wall to reduce the chance of hernia formation in future.
A small drain (plastic tubing) is placed in the breast area. Two small
drains are used for the abdominal area. A pain pump is used to help control
the pain in the abdominal area. It administers a continuous flow of a local
anesthetic medication to reduce the need for narcotic pain killers.
Recovery
Patients will leave the hospital after 3-4 days. The drains are removed
within 7-10 days after discharge from the hospital. The level of activity
is gradually increased over the following 4-6 weeks. Patients should avoid
heavy lifting for 6-8 weeks after surgery. An abdominal binder or other
compression garment is used over the abdomen to help with the healing
process.
Results:
The swelling in the reconstructed breast will gradually subside. This
may take up to 3 months. We allow for complete healing of the reconstructed
breast prior to any “touch-up” or nipple and areola reconstruction. It may
take up to 4 months for the tissue to regain its natural consistency and
feel. Additional procedures will be scheduled accordingly.
All the required procedures are covered by the health insurances,
including matching procedures on the uninvolved breast (''Women's
Health and Cancer Rights Act of 1998'').
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