Free TRAM reconstructions.
In free TRAM breast reconstructions, the bloodsupply of the skin and fat of the lower abdomen is disconnected to be reconnected again with vessels in the chest. This involves microsurgery, reconnecting vessels which can be as small as 1.5 mm in diameter.
The scars are the same as for a pedicled TRAM , i.e. a scar over the breast and one underneath in the fold, a scar across the lower part of your abdomen and one around the bellybutton, but the procedure takes 6-8 hours of operating time. The vessels used to reconnect the bloodsupply to the flap are found on
the inside of your ribs, I therefore take a small segment of a rib
nearest to the breastbone out, to get to these vessels, this may give you a small depression on your chest wall, though usually this is covered by the new breast.
The bulge in the upper abdomen is avoided completely.
After the operation you will be kept under very close observation.You will have an intravenous cannula in your hand (maybe your foot) and in your neck, a urinary catheter, supplementary oxygen and 4-5 drains. A nurse will take measure your pulse, bloodpressure, the colour and consistency and temperature of the flap, how much urine you are producing each hour for the first 48-56 hours.
Al in all you will not get that much sleep whilst we do all the observations, but it is crucial to keep a close eye on you until the bloodflow in the flap has been established properly,which happens after a couple of days when the little vessels which have been reconnected have healed.
To avoid a Deep Vein Thrombosis (DVT) you will have white graduated
pressure stockings on until you go home and intermittent pneumatic calf
compressors on your legs, which massages your calves when you are in bed and a daily injection of Clexane, a drug which thins your blood.
You will be in bed with your hips and your knees bent, just like after an abdominoplasty and it will take a week before you'll be able to stand up straight.
You will be given extra fluid intravenously which will make you quite swollen, it is therefore a good idea to remove all rings before the operations. After a week or two you will be able to put them back on.
Day three or four you'll be sitting out in a comfortable chair in your room, but you will not be able to move around a lot. We will also remove all the intravenous lines and catheter as the week progresses.
Why would I choose the free TRAM?
If you are keen on a reconstruction which uses your own tissues only and avoids the bulge in the upper abdomen.
What happens if it fails?
If a TRAM fails you will still not have a breast. The scar on your chest may be the same as the scar you had from the mastectomy or even a bit wider, covered with a skingraft (skin is taken from the flap) if some of the skin on your chest was removed to make way for the new breast.
You will also have had an abdominoplasty.
The potential complications of a free TRAM are
Bad scars
Asymmetry
A collection of blood under the flap or the tummy, which needs removing 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
Flap failure
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