Breast Reconstruction with the TRAM Flap

Abstract

Breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap offers a completely autogenous tissue reconstruction for women requesting either a delayed or immediate breast restoration. The donor site scar on the lower abdomen is hidden by most clothing styles. The flap can be harvested as a pedicle flap based on the superior epigastric vessels, including one or both rectus muscles, depending on the volume of tissue required. During immediate reconstruction, both the oncologic and reconstructive surgeons can operate simultaneously, continuously communicating during the surgical procedure about the incisions and mastectomy defect. The match between the tissue volume of the patient’s abdominal TRAM flap and her desired breast size determines the eventual aesthetic success of the reconstruction.