Autologous Reconstruction Tram Flap
There are many techniques for using your own tissue to reconstruct your breast. This can be done at the same time as the mastectomy (removal of the breast) or in a delayed fashion sometime after the breast removal. TRAM flap – Transverse Rectus Abdominus Muscle Flap – uses tissue from your abdomen to build a new breast mound.
HOW IT WORKS
Consultation and Planning
Once you decide on mastectomy with your breast surgeon, you will come in for a reconstruction consultation. At this meeting, we will go over the types of breast reconstruction and make a plan specific to your medical needs and your personal goals. We will choose what breast size (bigger, smaller, or the same) you want to be. To be a candidate for TRAM reconstruction, you must have excess abdominal tissue and this will be assessed at your consultation. We will coordinate the surgery with your breast surgeon.
After the removal of your breast, there is not enough skin to create a similar sized breast. This is why tissue needs to be moved from your belly (TRAM).
The TRAM surgery uses the skin, fat, and muscle from your abdomen to create a soft, natural appearing breast. The resulting scar is similar to a c-section or tummy tuck scar. This surgery takes about 3-4 hours. You will have a drain in your abdomen and possibly your chest.
You will stay in the hospital for 3-4 days after surgery. During this time, the nurses will check your newly reconstructed breast to make sure that the blood supply to the new breast (TRAM flap) is good so that the tissue can survive in its new location. The nurses at the hospital will give you pain medicine, make sure you are not nauseated and can eat, and teach you how to take care of your drains and bandages before you go home. The drains will be removed at your follow-up office visit.
At home, you should not lift anything heavier than a gallon of milk for at least 2 weeks after surgery. You should walk around after surgery and NOT stay in bed. This is important to prevent blood clots. You may shower 48 hours after surgery. You should eat a healthy diet and as much protein as possible to promote good healing.
You may drive and return to work when you are no longer taking prescription pain medicine. Most people are able to return to a light duty job 2-3 weeks after surgery and may start exercising after 6 weeks.
Remember that everyone is different. Recovery time and progression is not the same for everyone. The times stated are typical for healthy individuals healing from this surgery. The normal progression of healing may be different for those with health problems, smokers, and those who have unforeseen complications after surgery.
Risks and Considerations
Advantages to TRAM Flap Surgery:
- Soft, natural appearing breast; can mimic your natural breast well
- No implant or foreign objects used
- Similar to a tummy tuck
Disadvantages to TRAM Flap Surgery:
- Longer operation and hospital stay
- Abdominal scars
With every surgery, there are risks involved including bleeding, infection, blood clots, pain, scarring, delayed healing and need for further surgery. Here are some complications specific to TRAM Flap Reconstruction:
When your abdominal tissue is placed in a new area, it has to learn how to adapt to living in that location, meaning it needs enough blood to survive. When it doesn’t get all the blood it needs, a part of it might need to be removed in another operation. Very rarely does the entire flap loose its blood supply and need to be removed.
Sometimes, some of the fat doesn’t get enough blood supply and that portion of the reconstructed breast becomes firm or hard to touch. The only way to make this firmness go away is to remove it, which requires an operation.
Human breasts are not symmetrical. After breast reconstruction, the reconstructed breast may be bigger or smaller, perkier or less perky than the other breast. An operation on the natural breast can be done to better match the reconstructed breast if this happens.