The traditional pedicled TRAM flap carries a serious risk of lower abdominal wall weakness and contour deformity. The procedure sacrifices the entire rectus abdominis muscle, creating abdominal weakness that may create unnatural protrusions, bulges, and areas of laxity that can become hernias. DIEP flap breast reconstruction also presents a much smaller risk of abdominal wall weakness and hernia.
Many women are told that there is no reliable way to repair these types of hernias or abdominal deformities. Others undergo unsuccessful attempts to repair the hernia and endure recurring hernias.
There is a specific type of abdominal wall reconstruction that reliably repairs TRAM flap hernias and abdominal bulges. It is known as extended mesh repair. It requires coordination between a general surgeon who specializes in hernia repair and a plastic surgeon. A limited number of practitioners perform this surgery nationally.
Types of TRAM Flap Hernia Repair Procedures
Minor Deformity Repair
In some cases, removing loose skin and tightening the abdominal fascia with stitches can resolve small contour abnormalities.
Large Bulge and Hernia Repair
- A surgical team reopens the healed TRAM flap incision to identify the area of the hernia or bulge
- Surgeons customize the repair based on this assessment of specific areas of weakness, which vary between patients
- The external oblique muscles are elevated
- Sutures are applied to address specific areas of weakness
- An extended mesh is secured to ligaments on the lower abdominal wall
- Surgeons use the external oblique muscles to reinforce the mesh and strenghten the repair
- The area is closed with quilting sutures
Risks & Benefits
Standard approaches to hernia repair frequently fail to repair TRAM flap deformities, resulting in recurrent hernias. Methods that place a mesh inside the abdomen via open incision or laparoscopy also fail to reliably correct this unique type of hernia.
Extended mesh repair is the only reliable approach to TRAM flap hernia repair. It results in lasting abdominal wall reconstruction. However, it can be challenging to find doctors who are experienced in this procedure, as it is relatively new.