During TRAM flap surgery, an incision is made along your bikini line and an oval section of skin, fat, blood vessels, and muscle is taken from the lower half of your belly, moved up to your chest, and formed into a breast shape.
If you're having a muscle-sparing free TRAM flap, less muscle should be moved than if you're having a traditional free TRAM flap or a pedicled TRAM flap. Make sure you understand clearly how much of the abdominal muscle is going to be used. For either of the free TRAM flaps, the tiny blood vessels that feed the tissue of your new breast are matched to blood vessels in your chest and carefully reattached under a microscope.
For a pedicled TRAM flap, the section of skin, fat, and muscle is slid through a tunnel under the skin up to your chest. The blood vessels of the pedicled TRAM flap are left attached to their original blood supply in your abdomen.
Either free TRAM flap procedure lasts about 6 to 8 hours. A pedicled TRAM flap takes about 4 hours.
After TRAM flap reconstruction surgery: You'll be moved to the recovery room after surgery, where hospital staff members will monitor your heart rate, body temperature, and blood pressure. If you're in pain or feel nauseous from the anesthesia, tell someone so you can be given medication.
You'll then be admitted to a hospital room. For all types of TRAM flaps, you usually stay in the hospital for about 5 days.
TRAM incision lines where you'll likely have scars
Your doctor will give you specific instructions to follow for your recovery. For detailed information on how to care for the dressings, stitches, staples, and surgical drains, visit the Mastectomy: What to Expect pages.
It can take about 6 to 8 weeks to recover from TRAM flap reconstruction surgery. Your doctor may recommend that you wear a compression girdle for up to 8 weeks after surgery. Because you've had surgery at two sites on your body (your chest and your belly), you might feel worse than a person would after mastectomy alone, and it will probably take you longer to recover. You'll likely have to take care of three incisions: on your breast, your lower abdomen, and around your belly button, and you'll probably have drains in your reconstructed breast and in your abdominal donor site. You may have a fourth incision under your arm if you had axillary node dissection at the same time.
As with any abdominal surgery, you may find that it's difficult or painful to sit down or get up from a sitting position. It also might be hard to get in and out of bed. Your doctor or physical therapist can show you how to use other muscles to compensate until your abdominal muscles heal. If you have severe pain, ask your doctor about medications you can take.
It's important to take the time you need to heal. Follow your doctor's advice on when to start stretching exercises and your normal activities. You usually have to avoid lifting anything heavy, strenuous sports, and sexual activity for about 6 weeks after TRAM flap reconstruction.
It sometimes takes as long as a year or more for your tissue to completely heal and for your scars to fade, and you may decide to have additional “finishing” work done, such as reshaping the flap or reconstructing a nipple.