The Tram Flap is one of many, different surgical procedures utilized in breast reconstruction surgery. The medical term is Transverse Rectus Abdominis Myocutaneous (TRAM) Flap. The procedure was developed several decades ago.
The Tram Flap is where the surgeon takes part of the skin, fatty tissues, and muscle from your abdominal area and relocates these to create your new breast(s). There are two types of Tram Flaps commonly used; each for different reasons, and each approach has its own advantages and disadvantages.
- The Free Flap. This is where the surgeon removes muscle, shin, fatty tissue and blood vessels from the abdominal area and moved up to where the breast reconstruction will take place. Blood vessels are reattached during microsurgery. The surgeon might also perform what is called a “muscle-sparing” free TRAM flap, meaning he/she seeks to use only a portion of the rectus abdominis muscle for the flap, versus of a big portion. Because less muscle is used, recovery can be quicker, and the patient could retain more abdominal strength.
- The Pedicled (Attached) Flap. The same, basic tissues, etc, are removed, except the muscle and the artery and vein remain attached. In this procedure, more muscle is used, thus raising likelihood of significantly decreased abdominal strength later on. The muscle is “tunneled” under the patient’s skin to the breast region. Most surgeons regard the Free Flap as being more successful, with fewer risks and a lower chance for complications arising.
Interestingly enough, many surgeons, such as those at the John’s Hopkins Breast Center, recommend against Tram Flap surgery. This is due to risks of bulging and chances of hernia, as postoperative lifting is greatly restricted. Said surgeons recommend procedures that can provide “safer and more natural results.”