TRAM Flap

November 12, 2012

TRAM Flap

The TRAM flap, although no longer the leading form of breast reconstruction surgery was an important and influential step for the development of reconstruction procedures.

Overview

Now over taken by the DIEP flap as the leading standard of breast reconstruction surgery TRAM flap (Transverse Rectus Abdominal Myocutaneous Flap) was an influential concept and was responsible for the evolution and advanced progression of breast reconstruction procedures used today. There were 3 different types of TRAM flap surgical procedures commonly performed for purposes of mastectomy reconstruction:

The Pedicled TRAM flap

This procedure was the first to be based on the use of one of the rectus abdominal muscles, one of the muscles we use when we do a sit up. The procedure would begin with an incision made from hip to hip. From here one of the abdominal muscles as well as some fat and skin would be pushed under the skin all the way up into the chest to become a new breast. This surgery leads to a long and painful recovery with some long-term affects. For instance the patient will lose up 20% of their previous abdominal strength, which takes time to get used to. There are also potential complications as there are with all surgical procedures such as a delay in the healing time and process, fat necrosis, bulging and hernia.

The Free TRAM flap

In this procedure a similar amount of abdominal muscle and fat is used but instead of tunneling it up to the chest, in this procedure it is removed and then re-attached to the chest using microsurgery. This method has a faster recovery time and causes less potential complications. It is easier on the muscles so not as much abdominal strength is sacrificed and there is less risk of a hernia and abdominal bulging.

The Muscle-Sparing Free TRAM flap

This procedure is very similar to the free TRAM flap procedure except it uses substantially less muscle. The surgeon will take a piece of muscle as small as possible (usually around the size of a postage stamp) meaning there are a lot fewer complications affecting the abdominal area such as bulging, strength loss and hernia. Again this procedure uses a transplant method and removes the flap taken from the abdomen and re-attaches it to the chest.

As was previously mentioned these procedures have continues to develop and get better and better. Most commonly used breast reconstruction surgeries now used are the DIEP flap or SIEA flap procedures. However, if for some reason the anatomy of the patient makes these procedures less safe or too complicated then the muscle-sparing free TRAM flat procedure may still be used.

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