Pedicled TRAM Reconstruction.

What is a TRAM?
TRAM stands for Transverse Rectus Abdominis Myocutaneous , the muscle making the six pack at the front of the abdomen. Transverse because the skin of the tummy is taken in a transverse ellipse, Rectus is the name of the muscle, Abdominis means from the abdomen (we have a rectus muscle in the eye as well!) and Myocutaneous means containing both muscle (myo) and skin (cutaneous).
The TRAM flap is reconstruction of a breast using the lower abdominal skin and fatty tissue.

The skin and fat of the lower abdomen is supplied by vessels running behind and inside the rectus muscle and with a pedicled TRAM this tissue's own blood supply remains attached and the lower abdominal tissue is rotated into position on the chest. The tissue is then tunneled under the skin to the chest area, where it is brought through the mastectomy incision. The pedicled TRAM gives you a slight bulge in the upper abdomen, which disappears over time, probably within the next 2 years.
Your umbilicus will also be pulled over to the reconstructed side a very little bit.
You therefore have a scar as for an abdominoplasty across the lower abdomen and around the belly button, apart from the scars on your new breast,which are situated under the breast and over it. If you have had a skin sparing mastectomy you may only have a scar around the nipple and most of the skin on your new breast will be the skin from your old breast apart from the nipple area.



Taking one of the muscles of the tummy can weaken the area enough to give you a hernia, but the site can be repaired with a mesh so strong so that both muscles can be taken if a reconstruction of both breasts is needed.

The operation takes 3-4 hours and you will have drains both under you abdominal skin as well as your new breast. You will not be able to stand up straight for 3-5 days after the operation, because it is so tight, but you have in effect also had an abdominoplasty.
This is a very safe operation and the chance of failure is minimal.

Why should I choose a pedicled TRAM?
If you have had radiotherapy and do not wish to use the muscle in your back, this will also provide you with more skin and bulk. This type of reconstruction usually gives enough bulk so that there is no need for an implant. You do therefore not need any more surgery, once you are happy with the result.

The potential complications of a pedicled TRAM are
Bad scars
Asymmetry
A collection of blood under the flap or the tummy skin, which needs removing back in theatres
A collection of fluid (seroma) under the skin of the abdomen which needs repeated draining (probably the most common complication)
Abdominal hernia or abdominal wall weakness
Fat necrosis, which leads to hard areas within the flap or a prolonged discharge from the flap edges and you may need to go back to theatres for this
Flap failure (very very rare)
Deep Vein Thrombosis (DVT)
Pulmonary Embolus (arises from a DVT and is potentially fatal if not treated)

contact  0207 483 5090 or 07578 876 549 for consultations
any inquiries please email: plasticsurgeryjemec@gmail.com