TRAM (Transverse Rectus Abdominus Myocutaneous) Flap Breast Reconstruction

The TRAM flap was replaced by the DIEP flap as the preferred method of breast reconstruction performed by our surgeons many years ago. However, it is important to understand the concept of TRAM surgery and how it has evolved into today's cutting edge DIEP procedure.

There are three main forms of the TRAM flap operation commonly performed by plastic surgeons for mastectomy reconstruction:

1) The Pedicled TRAM flap: this was the first operation to describe use of one of the rectus abdominus muscles (sit-up muscle) for breast reconstruction. The surgery begins with an incision from hip to hip. Then, a “flap” of skin, fat and one of the patient’s abdominal muscles is tunneled under the skin to the chest to create a new breast. Recovery from the surgery is difficult and painful. Long-term, the patient has to adapt to the loss of some abdominal strength (up to 20%). As with any procedure there is the possibility of complications including delayed healing, fat necrosis (part of the tissue turns hard due to poor blood supply), loss of the reconstruction altogether (rare), and abdominal complications such as bulging and/or hernia.

2) The Free TRAM flap: this procedure involves disconnecting the flap from the patient's body, transplanting it to the chest, and reconnecting it to the body using microsurgery. Advantages over the pedicled TRAM include: improved blood supply (and therefore less risk of healing problems and fat necrosis), and less muscle sacrifice (so the abdominal recovery is a little easier, potentially more strength is maintained long-term, and the risk of bulging and hernia formation is lower). Since the tissue is disconnected and transplanted to the chest, there is also no tunneling under the skin as there is with the pedicled procedure and no subsequent upper abdominal bulge around the ribcage area (which is typically seen with tunneling).

3) The Muscle-Sparing Free TRAM flap: this operation is associated with all the benefits of the free TRAM but has significantly fewer abdominal complications and side-effects (pain, bulging, hernia, strength loss) because the vast majority of the abdominal muscle is spared and left behind. The amount of muscle taken is typically very minimal (postage-stamp size). The PRMA surgeons will opt for this surgery only if the patient's anatomy does not allow for the DIEP or SIEA flap to be performed. Learn more about the DIEP flap procedure here.

Please visit our Gallery to view breast reconstruction before and after photos. If you are considering restorative breast surgery and would like to schedule a consultation with one of our plastic surgeons, please contact our office today and a member of our staff will be happy to help you.

Latissimus Dorsi Flap


Home Surgeons Breast Reconstruction DIEP Flap Find A DIEP Surgeon SIEA Flap TUG Flap GAP Flap TRAM Flap Latissimus Dorsi Flap Breast Implants & Alloderm One-Step Perforator Flaps Abdominal Flaps New Technology Message Boards/Forums Our Experience Breast Reconstruction Blog Breast Cancer News Cosmetic Surgery Non-Surgical Face Breast Body Photo Gallery Abdominoplasty (Tummy Tuck) Arm Lifts (Brachioplasty) Body Lift Breast Augmentation (Breast Implants) Breast Lift Surgery Breast Reconstruction Surgery Breast Reduction Surgery Eye Lid Lift Surgery (Blepharoplasty) Face Lift Surgery (Rhytidectomy) Testimonials Leslie's Diary Patient Info DIEP Reconstruction FAQs Cosmetic Surgery FAQs DIEP Insurance FAQs Travel/Lodging Articles/Press/Radio Useful Links Breast Reconstruction State Laws Patient Safety Information Newsletter Contact Us Privacy Policies & Online Forms Site Map	Over 2,500 DIEP flaps performed Superior results Excellent reputation In network for most US insurance plans NO balance billing Patients treated from Texas, across the USA and all over the World PRMA of South Texas 9635 Huebner Rd. San Antonio, TX 78240 Phone: 210-692-1181 Toll Free: 800-692-5565 Fax: 210-692-7584 Click here to view map.	TRAM (Transverse Rectus Abdominus Myocutaneous) Flap Breast Reconstruction The TRAM flap was replaced by the DIEP flap as the preferred method of breast reconstruction performed by our surgeons many years ago. However, it is important to understand the concept of TRAM surgery and how it has evolved into today's cutting edge DIEP procedure. There are three main forms of the TRAM flap operation commonly performed by plastic surgeons for mastectomy reconstruction: 1) The Pedicled TRAM flap: this was the first operation to describe use of one of the rectus abdominus muscles (sit-up muscle) for breast reconstruction. The surgery begins with an incision from hip to hip. Then, a “flap” of skin, fat and one of the patient’s abdominal muscles is tunneled under the skin to the chest to create a new breast. Recovery from the surgery is difficult and painful. Long-term, the patient has to adapt to the loss of some abdominal strength (up to 20%). As with any procedure there is the possibility of complications including delayed healing, fat necrosis (part of the tissue turns hard due to poor blood supply), loss of the reconstruction altogether (rare), and abdominal complications such as bulging and/or hernia. 2) The Free TRAM flap: this procedure involves disconnecting the flap from the patient's body, transplanting it to the chest, and reconnecting it to the body using microsurgery. Advantages over the pedicled TRAM include: improved blood supply (and therefore less risk of healing problems and fat necrosis), and less muscle sacrifice (so the abdominal recovery is a little easier, potentially more strength is maintained long-term, and the risk of bulging and hernia formation is lower). Since the tissue is disconnected and transplanted to the chest, there is also no tunneling under the skin as there is with the pedicled procedure and no subsequent upper abdominal bulge around the ribcage area (which is typically seen with tunneling). 3) The Muscle-Sparing Free TRAM flap: this operation is associated with all the benefits of the free TRAM but has significantly fewer abdominal complications and side-effects (pain, bulging, hernia, strength loss) because the vast majority of the abdominal muscle is spared and left behind. The amount of muscle taken is typically very minimal (postage-stamp size). The PRMA surgeons will opt for this surgery only if the patient's anatomy does not allow for the DIEP or SIEA flap to be performed. Learn more about the DIEP flap procedure here. Please visit our Gallery to view breast reconstruction before and after photos. If you are considering restorative breast surgery and would like to schedule a consultation with one of our plastic surgeons, please contact our office today and a member of our staff will be happy to help you. Latissimus Dorsi Flap
	If you would like to schedule a consultation with one of our San Antonio plastic surgeons, please contact us today.
	TRAM flap breast reconstruction surgery, Texas (TX), USA - Plastic, Reconstructive and Microsurgical Associates (PRMA) of South Texas is one of the largest private practices in the US that performs microsurgical breast reconstruction. Our plastic surgeons are DIEP flap experts and perform over 350 DIEP flap operations in San Antonio each year. Patients are routinely welcomed from Texas (including Austin, New Braunfels, Dallas, Fort Worth, Houston, Arlington, El Paso, and Corpus Christi), out-of-state, as well as from outside the USA (including Mexico). Most forms of US insurance are accepted.