A TRAM flap has traditionally been one of the most commonly used types of breast reconstruction. In recent years, however, the advent of perforator flaps (such as the DIEP, SIEA, and SGAP flaps) has virtually eliminated the use of TRAM flaps in my practice. Virtually all patients who are candidates for a TRAM are also candidates for perforator flaps. Most patients will choose the perforator flap reconstruction over the TRAM when offered that option by their physician. Unfortunately, there are not many surgeons trained in the microsurgical skills necessary for perforator flap surgery so the TRAM flap continues to be done commonly in other practices. This page discusses TRAM flaps so that each patient can understand all their options and hopefully clarify the differences between TRAM flaps and perforator flaps. Perforator flaps are discussed in more detail on the DIEP/SIEA/SGAP page.

A "flap" is typically a combination of muscle, fat, and skin and can be taken from the patient's abdomen, back, or other parts of the body. In the case of a TRAM flap, the tissue is taken from the abdomen.

The type of TRAM flap (i.e. pedicle versus free, etc) simply indicates the method by which the surgeon moves the abdominal tissue up onto the chest site to create the new breast. The decision as to which method to use is made by the surgeon based upon the patient's anatomy and clinical situation. A "free" TRAM is one which involves using microsurgical techniques to move the tissue. Microsurgery is one of Dr. Duffy's specialties.

The TRAM flap involves tissue being moved from the abdomen and leaves the patient with a long scar across the lower abdomen. The scar, and the tissue removed, is very similar to that used during an abdominoplasty ("tummy tuck") so patients typically have a much flatter abdominal contour after surgery.

• Since the reconstruction involves using the patient's own tissues, the risks of implant reconstruction are avoided.
• It is typically easier to match the contralateral natural breast with the patient's own (autologous) tissues when compared with an implant reconstruction.
• When a TRAM flap is used patients essentially end up with a "tummy tuck" at the same time as the breast reconstruction.
• All of these advantages are also true of the perforator flaps.

• TRAM flap reconstruction generally requires a longer and more difficult surgery at the first stage when compared with implants. This usually means a longer recuperation for most patients.
• Many patients experience some abdominal muscle weakness following a TRAM flap. This is because some of the abdominal wall muscle is moved as part of the TRAM flap. This disadvantage is reduced by the use of the DIEP/SIEA flaps instead of the TRAM flap.
• There is the possibility of developing hernias at the site where the flap is removed from, due to the incisions made in the abdominal muscle wall. This disadvantage is also reduced by the use of the DIEP/SIEA flaps instead of the TRAM flap.
• Patients will have a scar across the lower abdomen where the flap is taken from.