Restorative Techniques

Breast Reconstruction with Muscle-Containing Flaps

Musculocutaneous flaps incorporate muscle in their design. Muscle removed from the donor site serves as a conduit through which the blood vessels that nourish the soft tissue of the reconstruction travel. Musculocutaneous flaps, such as the TRAM flap, used in breast reconstruction are considered to be less complex to perform than perforator flaps, and not surprisingly, they are more widely offered.

The sacrifice of muscle and fascia - the strong outer covering layer of muscle - from the donor site of any of flap is permanent. Muscle does not grow back. Removal of important functional muscle can lead to:

• Weakness that may be permanent
• Increased risk of developing a hernia or bulge
• More postoperative pain than for procedures that do not sacrifice muscle
• Longer recovery after surgery than for procedures that do not sacrifice muscle

The most commonly used flap for breast reconstruction is the Transverse Rectus Abdominus Musculocutaneous (TRAM) flap. With the TRAM flap or any of its variants (e.g., Free TRAM, MS TRAM), skin and fat, along with variable amounts of rectus abdominus muscle (“six-pack muscle”), are harvested from the lower abdomen.

The principal musculocutaneous flaps are:

• Transverse Rectus Abdominus Musculocutaneous (TRAM) Flap
• Free Transverse Rectus Abdominus Musculocutaneous (Free TRAM) Flap
• Muscle-Sparing Transverse Rectus Abdominus Musculocutaneous (MS-TRAM) Flap
• Latissimus Dorsi (LD) Flap

Perforator flaps allow a woman to have a breast reconstructed from her own tissue without sacrificing important muscles.