Restorative Techniques

MS TRAM Flap Breast Reconstruction

Muscle-sparing Free Transverse Rectus Abdominus Myocutaneous Flap Surgery

MS TRAM Flap Surgery

Like the pedicle-TRAM flap and the free-TRAM flap, the Muscle-Sparing free TRAM (MS-TRAM) includes skin, fat and muscle. The MS-TRAM flap is designed to remove less muscle from the abdomen than a standard free TRAM, but functional muscle is nevertheless permanently removed from the abdomen. Some surgeons performing DIEP flap procedures “convert” to free TRAM or MS TRAM flaps during surgery, so it is important to ask you surgeon if, and how often they find themselves needing to convert from a perforator flap to one of the TRAM flap procedures. Even muscle-sparing free TRAM flaps, designed to take less muscle than other TRAM flaps, may have greater impact on a woman’s abdominal wall than DIEP flaps and SIEA flaps that do not take any muscle at all.

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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.

Sacrifice of the Rectus Abdominus 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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Muscle-Preserving Methods of Breast Reconstruction

Our practice specializes in the most advanced methods of natural-tissue breast restoration, specifically, reconstructive surgery using microsurgical perforator flaps. Perforator flaps including the DIEP flap represent the state-of-the-art in natural-tissue breast reconstruction after mastectomy. Like the MS-TRAM flap, the DIEP flap uses excess tissue from the lower abdomen, however the abdominal muscles are not compromised with the DIEP flap technique.Perforator flap breast reconstruction techniques allow a woman to replace the breast tissue removed at mastectomy with soft, warm, living tissue without sacrificing important functional muscles.

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