TRAM and Free-TRAM Reconstruction

The general goals of breast reconstruction are to allow the patient to feel whole, balanced, and symmetrical, and to appear normal in clothing including a bra or swimwear. The reconstructed breast will always appear different when the patient is out of clothing, although with a TRAM flap reconstruction it is often possible to achieve very normal contour.

The TRAM and free-TRAM method involve transferring lower abdominal skin and fat to recreate the breast mound. In a free-TRAM, the flap is detached entirely and then reattached to blood vessels in the chest or axilla (armpit). This operation takes from 5-8 hours depending in large part on whether or not both breasts are being recreated. The hospital stay is usually 4-5 days. Full activity can resume after 4-6 weeks. Advantages of this technique include use of the patient’s own tissue and the ability to shape the tissue to match the remaining breast more accurately. In addition a flatter abdomen (tummy tuck) is also achieved. Once the patient has recovered the result is long-lasting and there are fewer long term complications than with an implant. Minor adjustment, if necessary, can be made at a second outpatient operation when the nipple/areola reconstruction is done. Disadvantages include the lengthier operation and post-op stay. Blood transfusions are rarely necessary (<5%). In the case of the free-TRAM, there is a risk of complete flap loss (5%). If flap loss occurs, another reconstructive technique can be used. My preference for a free-TRAM over a pedicled TRAM is because of the more robust blood supply, ability to safely transfer more tissue when it is needed, and quicker recovery with less abdominal dissection. However, the operation does take longer and there is the risk of losing the entire flap.

We have a list of patients who have undergone this operation and have offered to talk to others about their experience. Treatment of the opposite breast to create symmetry can also be achieved simultaneously if so desired.