TRAM stands for transverse rectus abdominis, a muscle in your lower abdomen between your waist and your pubic bone. A flap of this skin, fat, and sometimes part of the muscle are used to reconstruct the breast in a TRAM flap procedure.
Overall, TRAM flaps are the most commonly performed type of autologous reconstruction, partly because TRAM flap tissue is very similar to breast tissue and makes a good substitute.
There are two main types of TRAM flaps:
- Free TRAM flap: In a free TRAM flap, fat, skin, blood vessels, and some muscle are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. Your surgeon carefully reattaches the blood vessels of the flap to blood vessels in your chest using microsurgery. There is also what's called a "muscle-sparing" free TRAM flap. This means that your surgeon tries to use only a small part of the rectus abdominis muscle for the flap, instead of a large portion of the muscle. Because only a small part of the muscle is used in a muscle-sparing TRAM flap, most women recover more quickly and have a lower risk of losing abdominal muscle strength.
- Pedicled TRAM flap: In a pedicled TRAM flap, fat, skin, blood vessels, and muscle from your lower belly wall are moved under your skin up to your chest to rebuild your breast. The blood vessels (the artery and vein) of the flap are left attached to their original blood supply in your abdomen. (The artery and the vein are the "pedicle.") Pedicled TRAM flaps almost always use a large portion of the rectus abdominis muscle and are known as "muscle-transfer" flaps. Recovering from a pedicled TRAM flap can take longer than recovering from a muscle-sparing free TRAM flap because more muscle is used.
Tissue can be taken from your belly for breast reconstruction only once. So if you're thinking about prophylactic removal and reconstruction of the other breast, you might want to make that decision before you decide on reconstruction. If you have TRAM flap reconstruction on one breast and then later need reconstruction on your other breast, tissue for the second, later reconstruction will have to come from your buttocks, inner thighs, or back. Or you can have reconstruction with an implant.
Because skin, fat, muscle, and blood vessels are moved from the belly to the chest, having a TRAM flap means your belly will be flatter and tighter -- as if you had a tummy tuck. Still, a TRAM flap does leave a long horizontal scar -- from hipbone to hipbone -- about halfway between the top of your pubic hair and your navel. In most cases, the scar is below your bikini line. After the skin and fat are removed from your belly, your navel may be in the wrong place or distorted in some way, so your surgeon may have to reshape your navel.
While it's the most popular autologous breast reconstruction procedure, a TRAM flap isn't for everyone. It's not a good choice for:
- thin women who don't have enough extra belly tissue
- women who smoke
- women who already have had multiple abdominal surgeries
- women who plan on getting pregnant
Learn more about TRAM flap reconstruction on these pages: