Breast Reconstruction Using TRAM Flap / Free TRAM Before & After Photos Performed by Franklyn Elliott, M.D. After your breast has healed from reconstruction or mastectomy, a plastic surgeon can reconstruct a new nipple and areola. If these fail, then there can be "flap death," and the new breast will be lost. surgeons or share your journey with other people just like you on the Patient Community. The TRAM flap procedure is the right fit for some patients, but it is important that your choice takes into consideration your body type, health, lifestyle, and personal reconstruction goals. New Reply Follow New Topic. TRAM flap: Also known as transverse rectus abdominus myocutaneous flap, a surgical technique that uses muscle, fat and skin from your own abdomen to reconstruct the breast. How is this TRAM flap reconstruction done? Before surgery, follow your doctor's instructions on preparing for the procedure. Breast reconstruction with flap surgery is the most complex breast reconstructive option. Using complex microsurgical techniques, the blood vessels are attached to the ones in your chest and the skin and fat are used to create a breast. The plastic surgeons and care team members who perform breast reconstructions and help patients recover from the procedure are experts in their field. Cancer Australia aims to reduce the impact of cancer, address disparities and improve outcomes for people affected by cancer by leading and coordinating national, evidence-based interventions across the continuum of care. Breast reconstruction- Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Staged reconstruction of right breast delayed after mastectomy with TRAM Flap. Skin, muscle and fat tissues are transferred from the donor site on the abdomen to the chest wall. Some surgeons prefer the "free flap" method to the "tunneling" method because they may be better able to sculpt the tissue to the shape of a normal breast (and thus to match the other breast). Mammography isn't necessary on breasts that have been reconstructed. You may also choose to perform breast self-exams on your natural breast and the skin and surrounding area of your reconstructed breast. Each technique has different advantages and disadvantages. COVID-19 information for people affected by cancer, Managing your cancer care in the context of COVID-19, COVID-19 information for children and young people with cancer, Cancer and COVID-19 - what it means for our Mob, COVID-19 vaccines: Information for Aboriginal and Torres Strait Islander people affected by cancer, Cancer care for cancer patients with COVID-19, Cancer care in the time of COVID-19: A conceptual framework, Optimal cancer care during the COVID-19 pandemic: the Principles, The impact of COVID-19 on cancer services, COVID-19 Recovery: Implications for cancer care, Changes to prevention and early detection, Innovative care and hospital infrastructure models, Collaboration in the oncology sector and data sharing, Working with Aboriginal and Torres Strait Islander people, For Aboriginal and Torres Strait Islander people, Comparing different types of breast reconstruction, Possible complications of a tissue flap breast reconstruction, What to expect with a TRAM flap breast reconstruction, Other tissue flap breast reconstruction procedures, Breast reconstruction after preventive mastectomy, Post-operative recovery after a TRAM flap breast reconstruction, Questions to ask your breast reconstruction surgeon. One of the benefits of a TRAM flap breast reconstruction is that the breast(s) can be reconstructed without needing implants. The good news, is that you can have breast reconstruction surgery. Choose a board-certified plastic surgeon and be confident you are in the care of a highly trained surgeon you can trust. Don't be surprised if it seems to take a long time to bounce back from surgery some women report that it takes as long as a year or two before feeling completely healed and back to normal. Avoid exposing scars to sun for at least 12 months. Unlock access to Before & After Photos, Ask a Surgeon and Patient Community with a Connect account on the ASPS website. Frequently not just breast volume, but also skin surface area needs to be restored. Accessed Nov. 13, 2018. During a free TRAM flap procedure, the surgeon disconnects a section of abdominal tissue including skin, fat and sometimes muscle from its blood supply and attaches the tissue to blood vessels in your chest area using microsurgical techniques. The main difference in the free TRAM reconstruction is that the tissue, rather than remaining attached, is completely removed from the body. A pedicled TRAM flap uses your whole rectus muscle one of the four major muscles in your abdomen. In a properly performed DIEP, no abdominal muscle is cut or removed. . In a DIEP flap reconstruction, fat, skin, and blood vessels are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. Breast surgery, which will make you look normal. Sbitany H. Breast reconstruction. Make a donation. Brigham and Women's Hospital, Desire reconstruction using your own tissue, Do not want or are not a candidate for implant reconstruction, Have enough abdominal wall tissue to create one or both breasts, Are having immediate reconstruction at the time of skin-sparing mastectomy, Are having delayed reconstruction following prior mastectomy. A woman showing the lines of TRAM reconstruction incisions. In general, this means cutting away at least some of your stomach muscles, fat and blood. You'll also have stitches (sutures) after your surgery. The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons. The fat, blood and rectus abdominus are pulled through a tunnel that is created under the skin to form a breast mound or a pocket for a breast implant. To complete this operation, surgeons use tissue from your lower abdomen to create a new breast. The Pedicled TRAM Flap is a traditional approach that transfers tissue from that area with the rectus muscle to the chest to create a breast. The thought of losing my breast made me contemplate suicide. The study aimed to evaluate the effectiveness of primary breast reconstruction using the TRAM-flap procedure in patients with an inflammatory form of breast cancer. Unlike in DIEP flap, TRAM flap procedures can potentially have a negative effect the muscle wall in the abdomen because a section of the muscle is taken away. Image Credit This site complies with the HONcode standard for trustworthy health information: verify here. Flap reconstruction. Your doctor can prescribe medication to control your pain. Candidates for TRAM flap breast reconstruction Still, the abdomen ends up looking smaller and flatter afterward. Your surgeon removes tissue including muscle from your abdomen in a procedure known as a transverse rectus abdominis muscle (TRAM) flap. However, it does take a while before you feel normal again. Dhruv Gupta, MD answered this TRAM Flap Procedure For Breast Reconstruction . The plastic surgeon also provides information on anesthesia, where the operation will be performed and what kind of follow-up procedures may be necessary. Your reconstructed breast will not look and feel exactly the same as your . By submitting this form, you accept the Cancer Australia privacy policy. Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition. TRAM (transverse rectus abdominus muscle) flap procedure harvests abdominal tissue. Townsend CM Jr, et al. Conversely, a "muscle-sparing" free TRAM flap uses a smaller portion of the rectus muscle, so women tend to recover more quickly and have a lower risk of losing abdominal muscle strength. are very slender (because there may not be enough abdominal tissue for this procedure). It creates a natural-looking breast. Smokers should stop cigarette smoking and nicotine substitutes for at least 4 weeks before the scheduled operation. It is brought up and out through the mastectomy site (or scar depending on time of reconstruction). This is some of the same tissue that is taken during a "tummy tuck" procedure. The procedure's name comes from "Transverse Rectus Abdominis Muscle." A small portion is removed along with fat, skin and blood vessels. Objective: Patients with and without radiation treatment before their breast reconstruction were compared to study the relationship of radiation to flap-related complications. During a full breast reconstruction consultation, you'll have the opportunity to discuss your specific aesthetic goals and personal health concerns with your plastic surgeon, so that you can work together to find an approach that will give you the best possible results. Transaxillary incision: An incision made in the underarm area. https://www.uptodate.com/contents/search. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Once you have decided that breast reconstruction is right for you, you will need to discuss your personal goals and preferences with your surgeon to identify which surgical option would be most successful for your body type and personal goals. Boughey JC, et al. During a deep inferior epigastric perforator (DIEP) flap procedure, the surgeon removes a section of abdominal skin and fat, along with the associated blood vessels. Your surgeon removes tissue including muscle from your abdomen in a procedure known as a transverse rectus abdominis muscle (TRAM) flap. . Scarring is permanent, but the scars generally fade over time. This muscle is elevated off the back with skin, fat, and attached blood vessels (thoracodorsal artery and vein) and transferred through the armpit into the breast pocket. . Patients who have undergone this procedure often subsequently undergo computed tomography (CT) for assessment of metastatic disease or unrelated pathologic conditions. Benefits of breast reconstruction after fighting cancer, Answers to common questions about breast reconstruction, Understanding your options for breast reconstruction following mastectomy, What you need to know about your breast reconstruction options. It will also outline the physiotherapy exercises you can do, to help you recover from your surgery as quickly as possible. Because adequate blood supply is critical to the survival of transplanted tissue in flap surgery, your surgeon may prefer not to perform a pedicled flap procedure if you're a smoker or if you have diabetes, vascular disease or a connective tissue disorder. During the operation, your surgeon will assess the blood vessels in your lower abdomen. Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. The views expressed in Ask a Surgeon and the Patient Community are those of the Abdomen (TRAM flap). An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks. Anesthesia: A pedicled TRAM flap is performed with the patient under general anesthesia. It uses the lower abdominal skin, fat and rectus abdominal muscle. Breast Reconstruction Using TRAM Flap / Free TRAM Case #5. A TRAM flap uses donor muscle, fat and skin from a woman's lower abdomen to reconstruct the breast. Photo prior to nipple and areola reconstruction. We suggest scheduling a consultation with one of our experts in breast reconstruction. The procedure is done under general anesthesia. TRAM Flap Breast Reconstruction TRAM flap (transverse rectus abdominis muscle flap) involves reconstructing the breast using tissue and muscle from the lower abdomen. A diagnosis of cancer marks the beginning of a journey full of emotional, psychological, physical and practical challenges. Why TRAM Flap Breast Reconstruction? Our business hours are 9am to 5pm, Monday to Friday. Because TRAMP flap takes a section of the muscle wall, you will not be able to lift heavy weights during recovery. TRAM (transverse rectus abdominis muscle) flap uses tissue from the lower abdomen. Flap reconstruction requires specialized training in reconstructive microsurgery, which not all breast surgeons have. Depending on the size and condition of the blood vessels, they will perform one of the following procedures. Updates, advice and lifestyle tips from the ASPS delivered directly to your email inbox. It takes between 2 to 4 hours depending on the size of the breast and whether any procedure will be done on the normal breast to lift, reduce, or shape it in any way. TRAM Flap Breast Reconstruction. O'Halloran N, et al. Of the 26 TRAM flaps, 17 were immediate and 9 were delayed . You may be interested in the final touches of either nipple reconstruction or 3D nipple tattooing. TRAM flap proceduresuse the tissue from a woman's abdomen to create a mound to reconstruct the breast. Breast reconstruction is an opportunity to move forward, and we can help make it the best experience possible for you. Instead, the 2021 code revisions . This procedure involves the creation of a new breast mound using skin and tissue taken from the abdominal region and has proven to be very effective in many patients who have been affected by breast cancer. In some cases, the skin and tissue need to be augmented with a breast implant to achieve the desired breast size. The surgery's tongue-twister of a name comes from the branches of the primary blood vessel relocated during the procedure, the deep inferior epigastric perforator (DIEP). Tissue from your back or less commonly your buttocks may also be used. The treatment that your doctors recommend will depend on the type of cancer you have, how advanced it is, and other personal factors. Mean patient age was 49 years. In the TRAM procedure, the skin, fat, and muscle of the lower abdomen are used to recreate the breast. A pedicled TRAM flap uses your whole rectus muscle one of the four major muscles in your abdomen. Additionally, as with all forms of surgery, patients should have no medical conditions, other illnesses or habits (such as smoking) which might impede the healing process, and should also have a thorough understanding of what the procedure will entail as well as reasonable expectations about its outcome. Within six weeks, patients may return to driving, some work (depending on job requirements) and light exercise. The recuperation after a TRAM flap is longer than after staged implant procedures. This is not a microsurgical procedure. A TRAM flap breast reconstruction may NOT be the best option if you: Breast reconstruction techniques which use tissue flaps that rely on a supply of blood may not be suitable for people who smoke. While each approach has distinct advantages that allow it to be customized to the needs of the individual patient, one of the most effective and versatile of the autologous tissue breast reconstruction methods is still the classic TRAM flap breast reconstruction technique. Some women also consider it a bonus that the tummy is left relatively flat after removing the tissue flap (a tummy tuck effect). The latissimus dorsi pedicle flap is another common option for breast reconstruction. After surgery, you will remain under close observation for three to five days. TRAM flap (and other abdominal flap based breast reconstruction) can weaken the abdominal wall, causing abdominal bulges. The main concern about the free TRAM procedure is that the reconstruction depends upon the newly attached blood vessels to the flap tissue. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed . This allows the surgical team to closely monitor blood flow to the newly constructed breast, ensuring that the flap is healthy. Read more. Contralateral prophylactic mastectomy (CPM) consensus statement from the American Society of Breast Surgeons: Data on CPM outcomes and risks. In the pedicle ("tunneling") method of this procedure, this tissue is separated from its original location (without being completely disconnected), turned upwards, and tunneled under the abdomen. National Cancer Institute. 2022 The initial TRAM flap operation is 3-5 hours with 4-6 weeks recovery You may require 1 or more revision surgeries to shape and tweak your new breast. In these cases, breast reconstruction usually requires either a flap technique or tissue expansion. DIEP stands for the deep inferior epigastric perforator artery, which runs through the abdomen. January 2018 edited April 4 in Breast Cancer #1 TRAM FLAP RECONSTRUCTION AND ABDOMINAL BULGE/PAIN I had the Bilateral Pedicle Tram Flap in 2012. Most patients are back to their regular routines and full activities in eight weeks. Individual patients will heal at different rates, so recovery times can vary, however, patients should expect to experience some soreness and swelling in the affected areas for several weeks before full mobility is restored. Transverse rectus abdominus myocutaneous (TRAM) flap breast reconstruction involves rebuilding a breast shape by moving skin, fatty tissue and part of the rectus abdominus muscle from the abdomen (stomach) to the chest. Prolonged time in surgery and under anesthesia, Tissue death (necrosis) due to insufficient blood supply, Loss of sensation at the tissue donor site, Help your breasts look natural under clothing or a bathing suit, Help you avoid the need for using a form (external prosthesis) inside your bra, Partially erase the physical reminders of your disease, Require additional surgery to correct reconstructive problems, Give your reconstructed breast the same sensations as your normal breast. This video is available for instant download licensing here: https://www.alilamedicalmedia.com/-/galleries/narrated-videos-by-topics/breast-reconstructionVoi. Using a natural tissue, instead of an implant, allows for the newly constructed breast to change alongside the natural breast, like in weight changes. The recovery from a TRAM flap procedure is also far more intensive. Surgery to remove your healthy breast (contralateral prophylactic mastectomy) can double the risk of surgical complications, such as bleeding and infection. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. Drains placed in the breast and donor area of the abdomen stay in place for two to three weeks while the patient recovers at home, and are taken out during an office visit. The 2 most common types of tissue flap procedures are the TRAM flap (or transverse rectus abdominis muscle flap), which uses tissue from the lower tummy area . The skin, fat, and at least one abdominal muscle are tunneled underneath the skin upward into the breast area but remain attached to their blood vessels in the abdomen. A TRAM flap usually doesn't require an implant as long as there's enough excess skin and fatty tissue in the lower abdomen. ery, Reconstructive surgery, Breast reconstruction, Liposuction, Flap surgery, Breast reconstruction with breast implants, Breast surgery. The TRAM flap (Transverse Rectus Abdominus Myocutaneous) is a tissue flap procedure that uses muscle, fat, and skin from your abdomen to create a new breast mound after a mastectomy. The suturing of the area where the flap was taken from also . The TRAM flap reconstruction has been performed on women ranging in age from their late twenties to their mid-seventies. The hospital stay is anywhere between 3 to 5 . The best results are achieved when the procedure can be customized to the specific needs and body type of the patient, so your surgeon will give you detailed personalized instructions regarding medications, bandages and dressings, follow-up care and when you can return to normal, physical activity. It typically . An autologous flap procedure uses a combination of skin, fat, and/or muscle that is moved from areas such as your abdomen, upper back, upper hip, or buttocks to the chest where it is shaped into a new breast. One of the benefits of a TRAM flap breast reconstruction is that the breast (s) can be reconstructed without needing implants. Getting back to normal activities may take up to six weeks or more. A free TRAM has several important advantages over the pedicled TRAM flap. The free TRAM flap is a breast reconstruction that uses the abdominal tissues from the belly button to the pubic area to reconstruct one or both breasts. Ultimately, breast reconstruction can lessen the physical and emotional impact of mastectomy and help patients feel as though they are finally taking back control of their lives. A single copy of these materials may be reprinted for noncommercial personal use only. Report Sexual Misconduct, Discrimination and Harassment, Alternative donor sites for breast reconstruction, Copyright 1995-2022 Regents of the University of Michigan. DIEP Flap Breast Reconstruction Surgery requires about two to three hours to perform. Your surgeon determines which method is best for you based on your body type and your medical and surgical history. Some women may experience a change in breast sensation after breast reconstruction surgery, and some scarring at the incision sites will occur. Wearing an elastic bandage or support bra can help keep swelling down and support your breast while it heals. Pedicled TRAM flap reconstruction moves skin, fat, and muscle from the abdomen to recreate the breasts. If you don't have excess abdominal tissue or you've had abdominal surgery in the past, you may not be a candidate for a TRAM flap reconstruction. - Steady change in breast sensation after breast reconstruction stands for the TRAM. 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