TRAM Flap Breast Reconstruction
TRAM Flap breast reconstruction is named after the Transverse Rectus Abdominus Myocutaneous Flap, a technique that moves tissue from the abdomen to the chest for reconstruction of the breast mound. In Guilford, Dr. Collins can perform several different variations of the TRAM procedure, including the bipedicled, unipedicled or free TRAM techniques.
There are several options to consider for the patient considering breast reconstruction. The TRAM procedure may be recommended, but remember to consult with a plastic surgeon who has knowledge of the various techniques in breast reconstruction, so you can be fully informed about your options.
Who Should Get a TRAM Flap Reconstruction?
In general, any woman who is undergoing (or already undergone) a mastectomy should consider the TRAM flap breast reconstruction technique. Specific indications for the traditional (pedicled) TRAM technique include:
- Mastectomy defect requires a large amount of tissue
- Patient has undergone radiation of the chest wall
- Unsuccessful breast implant reconstruction
- Large or small opposite breast that is difficult to match with a breast implant
- Absence of recipient blood vessels for free flap breast reconstruction
TRAM is not recommended for obese patients, cigarette smokers, psychologically unstable patients or those who have undergone previous abdominal surgery. To fully understand the indications for TRAM flap breast reconstruction, it is best to consult with Guilford (New Haven area) plastic surgeon Beth Collins M.D. The doctor can explain the pre-operative steps, surgery and post-operative recovery period in detail.
What Does TRAM Flap Breast Reconstruction Do?
The TRAM procedure basically transfers tissue from the abdomen to the reconstructed breast. The pedicle is a part of the graft that is left attached at one or two points so vessels can provide a blood supply to the graft.
Before surgery, Dr. Collins may instruct you on preoperative steps for TRAM, which may include blood donation of one to two units and exercises to improve muscle strength and blood supply. You will also have a thorough consultation to understand the magnitude of your breast reconstruction procedure.
A TRAM procedure may involve several stages to achieve satisfactory results. During surgery, an incision is made on the abdomen (similar to abdominoplasty) and the tissue is tunneled beneath the chest wall to reconstruct the breasts. For proper blood supply to the graft, small parts are left attached to the abdominal muscle. The reconstructed breast is shaped to match the opposite breast. At the abdomen, the navel may need to be relocated, and the surgeon may perform liposuction and tailoring of the skin for an optimal aesthetic result.
After TRAM: What Should I Expect?
Dr. Collins will guide you through recovery and provide specific instructions to help you get back to your routine as soon as possible. Breast reconstruction generally requires four to five days in the hospital. However, patients can be mobile after the first day of recovery. Surgical drains will be in place four one to two weeks.
It may take six weeks or longer before you regain your normal energy level and can return to your routine. Abdominal exercises can typically be performed after about eight weeks, but you may have a tight feeling in the abdomen for several months.
Related Procedures and TRAM Alternatives
One possible alternative to the traditional TRAM procedure is the Free TRAM flap. Dr. Collins may recommend this procedure if she has concerns about adequacy of the blood supply. Rather than tunneling the tissue to the chest, the Free Tram completely removes the tissue and replants it at the breast mound, using microsurgery to attach the graft to new blood vessels at the recipient site. Other breast reconstruction techniques include the DIEP Flap or implant based breast reconstruction.
Do you have questions about TRAM flap breast reconstruction? Contact Guilford CT plastic surgeon Dr. Beth Collins for more information on this procedure. Our practice is conveniently located for patients in New Haven County, Madison, Guilford and other communities in the state of Connecticut.