TRAM Flap Breast Reconstruction Boston

The TRAM (Transverse Rectus Abdominal Muscle) flap procedure uses abdominal tissue to reconstruct the breast. The TRAM flap provides enough tissue to completely rebuild the breast mound in most patients. As this type of procedure often leaves the stomach area flatter, it is often referred to as a “tummy tuck” reconstruction.

TRAM flap procedures are categorized as being either “attached” or “free”. In the “attached” (or pedicled) TRAM flap, skin and fat are removed from the donor site, and then tunneled under the skin to the chest and shaped into a breast. The new breast tissue mound remains connected to its original blood supply, thus being described as “attached” or pedicled. The connection of the blood supply is via the rectus abdominis muscle. Doctor Darrow tends to perform this operation after strengthening the blood supply to the skin by completing a “delay” procedure where some (but not all) of the vessels are severed. The remaining vessels are left intact for about two weeks while they strengthen up (dilate) to be used as a pedicled flap.

The “free” TRAM flap constitutes a transplant in which tissue is completely removed from the abdomen and is then reattached to the breast area using microsurgical techniques that reconnect the small blood vessels from the flap to vessels found in the chest area. No delay procedure is required with this technique.

TRAM flap surgery is a major operation in either case – four hours under general anesthesia for an attached procedure, usually six hours for the free procedure. A blood transfusion may be needed, particularly in the case of chemotherapy. Typically, a 2-3 day hospital stay is required, and, after six to eight weeks, normal daily activity can resume.