About Us Procedures Laser Treatments Wrinkle Treatments Patient Testimonials Photo Gallery

Breast Reconstruction - TRAM

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.


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.


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'').





  • Breast Augmentation
  • Breastlift
  • Breast Reconstruction

  •          DIEP
             Nipple Sparing mastectomy
  • Breast Reduction
  • Body

    Excessive Sweating

    Contact Us
    Patient Support
    Useful Links



    Terms and Conditions

    Copyright 2004-2017 Hooman Soltanian, M.D.