The TRAM flap breast reconstruction procedure is currently the most common procedure for the transfer of living tissue. It is performed in two distinct ways, using the pedicled flap procedure and the free flap procedure.
For both forms of the TRAM flap breast reconstruction procedure, a strip of skin, fat and muscle is removed from the abdomen and used to create the new breast shape. In some cases, an implant may be added to the procedure to increase breast volume.
When to Consider a TRAM Flap Breast Reconstruction
Ideal TRAM flap breast reconstruction candidates are in good overall health and are interested in using their own tissue for reconstruction. You may require a breast reconstruction following:
- Single or double mastectomy
- Severely damaging lumpectomy
- Chest injury
- Other types of failed reconstruction
Smoking may have a negative effect on wound healing, and you should discuss this with Dr. Mosiello prior to the procedure. If you have too little abdominal fat may you may not be a good candidate for this procedure.
What are the steps of the TRAM flap breast reconstruction procedure?
A general anesthetic or intravenous sedation is first given for your comfort. A strip of muscle, fat and skin is removed from the transverse rectus abdominis myocutaneous (TRAM) area of the abdomen. This removed portion is similar to the portion removed during a tummy tuck, which is one of the added benefits of this procedure.
An incision is made over the breast to be reconstructed and the flap is set over the breast. This incision may be made along the original mastectomy scar.
In the pedicled process, the original blood supply is retained, and in the free procedure, the flap is connected to a new blood supply. In both procedures, the breast is then shaped and the nipple created. The tissue is secured in place with internal sutures, and the incisions closed with very fine sutures for minimal scarring.
How long is recovery following the procedure?
Bandages and dressings may be applied immediately after the procedure. Drains may be put in place to remove any fluid buildup. A compression garment is often worn for the first few weeks to protect the breast, keep it in place and minimize swelling or bruising.
Swelling should begin to go down within a few weeks. At this point the final appearance of the area will become more clear.
Arm motion may be limited for the first few weeks, after which time a physical therapy program may be implemented. Regular activities can often be resumed in 2-3 weeks, but 6-8 weeks may be required before full recovery is complete.
Is there scarring from a TRAM flap breast reconstruction?
Typically the mastectomy scar is used as the new breast incision, which becomes an elliptical shape that extends across the breast. The abdominal scar runs from hip to hip along the underwear line for minimal visibility. There may also be a scar around the belly button.
The underlying tissues are secured with internal sutures to remove pressure from the external incision closures. These are secured with fine sutures for minimal scarring. Incision lines will continue to fade for up to a year.
How will I feel after the procedure?
There may be some discomfort in the stomach, breast and arm area for the first few days or weeks. This discomfort may be managed with prescription or over-the-counter medications.
Are there any possible complications?
A full discussion of your potential risks will be a part of your initial consultation. One possible complication of the TRAM flap breast reconstruction procedure is asymmetric breast appearance. This can often be fixed through surgical reconstruction of the other breast.
Poor blood supply to the new flap may also occur, which would require surgical correction. As in other surgeries of this nature, infection, poor wound healing and bleeding may occur.
Learn More About TRAM Flap Breast Reconstructions in Tampa
For more information about TRAM flap breast reconstruction, or to schedule a personal consultation with Dr. Mosiello, contact us at 813-631-1500. For your convenience, our Tampa Palms office is conveniently located in New Tampa, near Wesley Chapel.