Types of Reconstruction Surgery – The TRAM Flap

Types of Reconstruction Surgery The TRAM Flap
Photo courtesy of freedigitalphotos.net and imagery majestic

Deciding upon which type of reconstruction surgery to have after losing part of your breast (or all of it) to breast cancer is often very difficult, so I decided to devote all of my blog posts this week to a discussion of the various types of reconstruction surgery that are available, together with a little feedback from women who have undergone each type of surgery.


The TRAM flap is the most common type of reconstructive surgery and utilizes the entire rectus abdominus muscle to create the new breast.

TRAM stands for “transverse rectus abdominus myocutaneous” which means that your surgeon takes the lower abdominal skin and fat up to the chest wall and a breast is then created using this tissue.

There are two methods of performing the TRAM flap procedure – one called “pedicle” flap and one called “free” flap.  To find out more about these two types, click this link.

In order to transfer the flap to the chest, the muscle is tunneled under the upper abdominal skin.  Many women choose this approach since the patient’s own body tissue is used and it feels like a pretty natural breast reconstruction.  Another benefit is that often you also get a flatter tummy.  The scar on the abdomen is low, and extends from hip to hip.

The TRAM flap can be used for reconstructing one or both breasts. In a patient undergoing a one-sided (unilateral) reconstruction, it’s felt that the TRAM flap can potentially offer better symmetry than using an implant.

To prevent the possibility of getting hernias somewhere down the track, most surgeons will use a synthetic mesh when closing the abdomen.

If you are a smoker, have diabetes or suffer from obesity, doctors do not advise having this surgery because of limitations in the flap blood supply.

Length of Surgery: for one breast, 4-5 hours; for both breasts, 5-7 hours (this may vary according to your surgical team).

Hospital Stay: 3-5 days

From A Practical Point of View…

After this surgery, it’s normal to have abdominal pain and tightness for several weeks, and that can last up to several months before you can return to a full range of activity.

Most patients report that it’s painful to cough or sneeze post-surgery (or even stand up straight) so if you find it necessary to do this, you’ll need to bend over at the waist to avoid pulling muscles.

Immediately after surgery, you’ll need to learn to roll over onto your side when getting out of bed, and then pushing yourself erect with your arms.

Some survivors recommend that you need to exercise as soon as you can post-surgery.  Walking, swimming, yoga, Pilates, Wii Fit are all wonderful to strengthen your back muscles because your stomach muscles will now be much weaker.  It’s very important to compensate for that by strengthening your back muscles.

One survivor mentioned that just standing still can be painful, it can make you feel tired much sooner than you might otherwise.

I’ve found a helpful YouTube video from a UK surgeon, Adrian Richards, explaining the difference between DIEP flap and TRAM flap.

If you choose to have reconstructive surgery, please read my article Tips For Surgery – Useful Items to Take With You.  Another article that might be helpful: My Top Favorite Things to Promote Surgery Recovery

If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com).  When you’re in a desperate situation, you need an ally.  You can depend on me to help you through this.

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2 thoughts on “Types of Reconstruction Surgery – The TRAM Flap

  1. Hi, love your website. Wanted to mention that there is a major difference between TRAM & DIEP flap, but I wish that you had put them on separate pages as they are not the same procedure. The focus of your page is the TRAM, with brief mention of the DIEP. The DIEP uses no muscle, so there is ultimately no permanent loss of core abdominal function. Extremely important for active women to be aware of this. I believe that the TRAM would be obsolete, if not for the fact that the DIEP is much more technically challenging and requires a highly experienced microsurgeon. Those who can’t perform the DIEP (and other free flap procedures such as GAP flaps) are still recommending TRAMS to their patients, and in my opinion, doing them a disservice. In the video that you’ve posted, Dr. Richards expressed his opinion that the DIEP is a far superior method of reconstruction to the TRAM.

    1. Dear Andrea,

      Thank you so much for your comments. Yes, of course I do know there is a major difference between TRAM and DIEP, and today’s article is all about DIEP. Each day this week I am dedicating one article to each type of reconstruction.

      I appreciate your input very much and so, I am sure, will my readers (especially the part about surgeons who recommend TRAMs!)

      Warmest regards,

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