Breast Reconstruction Explained - The TRAM Flap

If you are in need of a mastectomy and are looking at reconstructive surgery, the medical terminology can be overwhelming. There are many ways to restore the natural look of your breasts, and each has its advantages and disadvantages. There is no one "best" procedure, but understanding your options fully can help guide you to the one that fits best for you. Read on to clear up some of the mystery behind breast reconstruction.

A TRAM flap at its simplest is the mass of body tissue used as a replacement for breast tissue after a mastectomy. The tissue removed from the breast includes mammary glands, which produce milk, but also blood vessels, fat, skin, and nerves. If the mammary glands are lost they cannot be replaced, but the fat, blood vessels, and skin from another part of the body can replace the original breast tissue. A TRAM flap is a specific graft of body tissues that is used in breast reconstruction.

To fully understand the TRAM flap, it is important to understand the origin of the word. The acronym breaks down to "Transverse Rectus Abdominis Myocutaneous". This term may sound intimidating, but when broken down it is actually very simple. The first three words refer to the muscles involved in the graft of tissue that is used in the surgery. The transverse muscle runs horizontally across the abdomen just inside of the skin. The rectus abdomen muscles also reside in the lower torso and are commonly referred to as the "six pack". A "Myocutaneous flap" is a type of tissue graft than includes muscle.

With that in mind, the term Transverse Rectus Abdominis Myocutaneous or TRAM flap is used to describe a tissue graft that affects the rectus and transverse muscles in the abdomen. There are many other types of grafts used in other surgeries, but the tissue in the abdomen tends to work the best in breast reconstruction. The tissue near the stomach is very similar to breast tissue, so breasts molded out of these grafts are very similar to the touch. Unfortunately the nerves in the area must be removed during the procedure, so the patient will not have much sensation in the area.

To perform this surgery, a surgeon first marks off a long oval-shaped area just below the the stomach. This area is cut during surgery and pulled away from the rest of the abdomen. Typically the section of skin, fat, and muscle remains attached to the blood vessels that connect it to the rest of the body. Still tethered, the mass of tissue is moved underneath the skin to the new area of the body. In some cases, the tissue can be completely detached and reattached to the body, but this process is more complex and takes much longer. After the graft has been moved, the skin in the abdomen is stitched closed along the waistline.

Although the procedure is very involved, the TRAM flap is standard across the industry and it has been in use for many years. Generally patients recover within a few weeks and can return to their normal routine. Many alternative grafts exist, however, and it is good practice to check the different options to find what works for you.