What is a transverse rectus abdominis myocutaneous (TRAM) flap procedure?

Transverse rectus abdominis myocutaneous (TRAM) flap surgery was developed decades ago and is no longer considered "state of the art" in breast reconstruction.

In TRAM flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, is tunneled beneath the skin to the chest, creating a pocket for an implant-or in some cases, creating the breast mound itself.

With the TRAM flap, there is a risk of hernia or abdominal bulge. Also, newer procedures may offer more natural results.

A TRAM flap involves taking the skin and fat of the lower abdomen as well as one half of the rectus abdominus muscles, your core muscles. Two TRAM flaps (for reconstruction of both breasts) would take the entire core abdominal muscles. Keep in mind that not all muscles are created equal - your core abdominal muscles are critical to every day functions such as getting out of bed, rising from a chair, and even coughing, sneezing, or going to the bathroom. Other muscles may be removed without any functional impairment, but not the abdominal muscles. My personal approach is to spare functional muscle so that you can sit up from bed, get out of a chair, be able to do a sit up and minimize the risk of bulges or hernias. Therefore, a DIEP flap is a superior option because this technique spares the rectus muscle. The downside is that a DIEP flap is much more difficult to perform and requires specialized microsurgical skill, equipment and staff.  While you may not have access to a surgeon who performs DIEP flap reconstruction, done well, a TRAM flap can have good outcomes. However, I generally do not recommend a double TRAM flap reconstruction as it results in too much weakening of the abdominal wall. Nonetheless, the DIEP technique is becoming more and more popular and patients are seeking surgeons who are skilled and experienced with the technique.