I keep hearing about TRAM flap breast reconstruction. What is this all about?

Last Modified: May 8, 2009

Question

Dear OncoLink "Ask The Experts,"

I keep hearing about TRAM flap breast reconstruction. What is this all about?

Answer

Rachel McKenna, MSN, CRNP, Nurse Practitioner in the Division of Plastic Surgery at the University of Pennsylvania Hospital, responds:

The TRAM flap stands for transverse rectus abdominus myocutaneous flap. This type of reconstruction is when the skin, fat, and blood vessels are taken from your abdomen and transferred to the chest and made into a breast mound. There are two very different types of TRAM flap reconstruction and it is important to understand the difference.

One type of TRAM flap is a pedicled TRAM, this means that the flap is left attached to its original blood supply and is tunneled under the skin to the breast area. This type of surgery can significantly decrease the strength that you have in your abdomen. This type of surgery is usually not performed at HUP.

The other type of TRAM flap is a free TRAM, In this type of flap, the surgeon cuts the flap of skin, fat, blood vessels, and only a portion of the muscle from its original location, and sutures the blood vessels to donor blood vessels in the chest. Although this type of flap requires more skill, it preserves the strength and function of your abdominal wall.

There are 2 other special flaps that can be taken from the abdomen called the DIEP or SIEA flap, that also require suturing the blood vessels together. These flaps take NO muscle from your abdomen.

At HUP, the most common flaps performed are the free TRAM, DIEP, and SIEA flaps. The remainder of the questions here will only address this type of surgery.

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