Pedicled TRAM Flap Breast Reconstruction

This older natural tissue reconstruction approach uses the rectus abdominis muscle to reconstruct a breast.

Summary

Most natural tissue reconstruction makes use of tissue from the lower abdomen. The Pedicled TRAM Flap is a traditional approach that transfers tissue from that area with the rectus muscle to the chest to create a breast. The muscle carries the blood supply for the flap. This is not a microsurgical procedure.

Immediate hybrid reconstruction withDIEP flap and implant after nipple-sparing mastectomy.

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Immediate hybrid reconstruction withDIEP flap and implant after nipple-sparing mastectomy.

This procedure is still available, however, newer microsurgical techniques can create a breast reconstruction using abdominal wall tissue without sacrificing the rectus muscle. The breast reconstruction community has moved away from the pedicled TRAM flap procedure, which may put the abdominal wall at risk, in favor of options that preserve the muscle.

Procedure details:

  • Surgeons elevate skin and fat, along with the rectus muscle, from the lower abdomen
  • The rectus muscle carries the blood supply
  • Surgeons tunnel the skin, fat, and rectus muscle underneath the skin from the abdomen to the chest wall and use it to create a breast
  • A mesh material is used to repair the abdominal donor site, which is now missing a muscle

Risks & Benefits

This procedure sacrifices the rectus muscle, which can result in abdominal wall weakness and/or a unique type of bulge or hernia. The risk of developing a hernia remains very high despite the synthetic mesh used to repair the abdominal donor site. These hernias require a specialized type of repair. Pedicled TRAM flaps carry a risk of poor wound healing. These risks are higher in patients who smoke or are obese.

Given the risks associated with sacrificing the rectus muscle, abdominal free flaps—like the DIEP and SIEA—are typically preferred by patients and physicians who focus on breast reconstruction.