Like all surgery, TRAM flap surgery has some risks. Many of the risks associated with TRAM flap surgery are the same as the risks for mastectomy. However, there are some risks that are unique to TRAM flap reconstruction.
Tissue breakdown: In rare instances, the tissue moved from your belly to your breast area won't get enough circulation and some of the tissue might die. Doctors call this tissue breakdown “necrosis.” Some symptoms of tissue necrosis include the skin turning dark blue or black, a cold or cool-to-the-touch feeling in the tissue, and even the eventual development of open wounds. You also may run a fever or feel sick if these symptoms are not addressed immediately. If a small area of necrosis is found, your surgeon can trim away the dead tissue. This is done in the operating room under general anesthesia or occasionally in a minor procedure setting. If most or all of the flap tissue develops necrosis, your doctor may call this a “complete flap failure,” which means the entire flap would need to be removed and replaced. Sometimes the flap can be replaced within a short timeframe, but in most cases the surgical team will remove all the dead tissue and allow the area to heal before identifying a new donor site to create a new flap.
Lumps in the reconstructed breast: If the blood supply to some of the fat used to rebuild your breast is cut off, the fat may be replaced by firm scar tissue that will feel like a lump. This is called fat necrosis. These fat necrosis lumps may or may not go away on their own. If they don't, it's best to have your surgeon remove them. After having mastectomy and reconstruction, it can be a little scary to find another lump in your rebuilt breast. Having them removed can give you greater peace of mind, as well as ease any discomfort you might have.
Hernia or muscle weakness at the donor site: A hernia happens when part of an internal organ (often a small piece of the intestine) bulges through a weak spot in a muscle. Most hernias happen in the abdomen. They usually happen when someone who has a weak spot in an abdominal muscle strains the muscle, perhaps by lifting something heavy.
Hernias can be painful and can cause a noticeable bulge in your abdomen. Hernias usually are treated by surgically inserting mesh to support the muscle wall. The surgery is generally done on an outpatient basis. Hernias can often come back.
If you have a free TRAM flap or a pedicled TRAM flap, your risk of hernia is higher than if you have a muscle-sparing free TRAM flap. This is because more muscle has been moved to rebuild your breast and your abdominal muscles may be weaker. Even with a muscle-sparing TRAM flap, though, the cuts in the muscle can result in ongoing episodes of painful spasms (“charley horse”) that affect the muscle ends.
If you’re concerned about these risks, you might wish to consider procedures such as the DIEP flap or SIEA flap, which were developed to minimize these issues and are less likely to put you at risk for hernia, since they preserve all of the abdominal muscle.