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

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