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 blood and some of the tissue might die. Doctors call this tissue breakdown “necrosis.” Some symptoms of tissue necrosis include pain and bleeding, the skin turning dark blue or black, numbness, and sores that ooze a bad-smelling discharge or pus. You also may run a fever or feel sick. If this happens, your surgeon can trim away the dead tissue. This is done in the operating room under general anesthesia.
If you have either type of free TRAM flap, your risk of tissue breakdown is higher than if you have a pedicled TRAM flap. In a free TRAM flap procedure, the blood vessels of the flap are cut and reattached to blood vessels in your chest, so there's a greater risk of the tissue not receiving enough blood. A pedicled TRAM flap stays attached to its original blood supply in the abdomen, so there's less risk of the tissue not receiving enough blood.
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.
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.
Hernias can be painful and can cause a noticeable bulge in your abdomen. Hernias usually are treated by surgically repairing the opening in the muscle wall. The surgery is generally done on an outpatient basis.