Restorative Techniques

Free TRAM Flap Breast Reconstruction

Free Transverse Rectus Abdominus Myocutaneous Flap Surgery

The free-TRAM flap, a microsurgical procedure developed in the era before perforator flaps, overcomes some of the limitations of tunneling the TRAM flap, but it too destroys muscle at its donor site.

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Like the pedicle-TRAM flap, the free-TRAM flap includes skin, fat and muscle. Since the blood supply to the skin and fatty tissue established using the free-TRAM technique is more robust than that of the pedicle-TRAM procedure, more tissue with a healthy blood supply can be reliably transferred with a free-TRAM flap than with a pedicle-TRAM flap. This makes it possible to restore larger breasts than could typically be restored reliably using the pedicle-TRAM flap procedure. In addition, because free flaps do not use an attached pedicle that can limit how far a surgeon can move the harvested tissue, there is generally a greater degree of freedom when shaping these flaps into the form of a breast. Still, this method sacrifices muscle at the site from which the tissue is taken. In contrast to the free TRAM flap, DIEP flaps and SIEA flaps used for breast reconstruction preserve all of the abdominal muscle.

The Rectus Abdominus Muscle

The rectus abdominus is actually two muscles that lie next to each other, one on each side of the central portion of the abdomen, and that help us:

• Bend or flex at the waist
• Do a sit-up
• Rotate the body at the waist
• Keep the abdominal organs in place

When even one rectus abdominus muscle is removed from the abdominal wall, abdominal weakness, a bulge in the abdominal wall or a hernia can occur. These concerns are even more important for women planning on have both breasts reconstructed using TRAM flaps. Surgeons performing musculocutaneous flaps such as the TRAM flap, and even the “muscle-sparing” free TRAM flap, frequently place synthetic mesh or human tissue-derived Alloderm® in the abdominal donor site to try to reinforce it.

Sacrificing Muscle for Breast Reconstruction

Studies have shown that removal of muscle from a flap’s donor site can lead to:

• Permanent weakness
• Increased risk of developing a hernia or bulge of the abdomen
• More postoperative pain than following perforator flap breast reconstruction
• Longer recovery after surgery than for procedures that do not sacrifice muscle.

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Natural Breast Reconstruction Without Muscle Destruction

Our practice specializes in the most advanced methods of natural-tissue breast reconstruction, specifically, reconstructive surgery using microsurgical perforator flaps. Perforator flaps such as the DIEP flap and the SIEA flap represent the state-of-the-art in natural-tissue breast reconstruction. Breast reconstruction with a DIEP or SIEA flap means a women can use her abdominal tissue to replace a breast removed at mastectomy without sacrificing important functional muscles.

» Learn about natural-tissue breast reconstruction options that preserve muscle

» Contact us to schedule a consultation or for more information