Tram Flap Reconstruction

For breast restoration, women may consider the TRAM flap. TRAM stands for “transverse rectus abdominis myocutaneous,” named after a muscle located in the lower abdomen. There is generally enough skin, fat, and muscle in this area that can be used to reconstruct a new breast.

Just like the DIEP flap, the TRAM flap takes the excess lower abdominal skin and fat. However, unlike the DIEP flap, the TRAM flap also requires taking the underlying abdominal wall muscle. The muscle is required because the blood vessels that feed the overlying skin and fat reside inside the muscle.

Pedicle TRAM Outline	Pedicle TRAM Incision Sites

After Pedicle TRAM surgery

The skin/fat/muscle unit is then tunneled under the skin up to the breast to build a tissue only breast. In a pedicled TRAM procedure, the tissue’s own blood supply remains attached and the lower abdominal tissue is rotated into position on the chest. The tissue is then tunneled under the skin to the chest area, where it is brought through the mastectomy incision. There is usually no need for microvascular surgery in a pedicle TRAM procedure.

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