Who is a candidate for TRAM flap reconstructive surgery for breast cancer?

Stuart A. Linder, MD
Plastic Surgery

The TRAM flap is known as the Transverse Rectus Abdominis Musculocutaneous Flap. The tissue from the lower abdomen as with a tummy tuck may be transferred to the breast either by a pedicle (still attached to the abdominal wall) or a "free-flap". A free-flap requires removal the tissue and transferring to the breast via microscopic anastomosis to vessels in the axillary region. TRAM flap patients require a reasonable amount of tissue under the umbilicus as with an abdominoplasty. They should also be non-smokers. Smoking may reduce the oxygenation and circulation of the pedicle which could lead to death or necrosis of the flap.

Many women are cansdidates for TRAM flap reconstruction. Patients must be in good health and have adequate abdominal tissue to transfer to the breast.

I have had many patients where we’ve started the reconstructive process with an implant, but later changed to a TRAM flap for one reason or another. Other women have come back many years later with unsatisfactory implant reconstruction and prefer to use their own tissue. We can then electively remove the implant and put in the patient’s own tissue. This is a thoughtful process, and we have a thorough discussion with these patients before pursuing this treatment strategy.

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