TRAM stands for the transverse rectus abdominis muscle, which is located in the lower abdomen, between the waist and the pubic bone.

TRAM Flap breast reconstruction - preparation

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TRAM is the most popular of all reconstruction options, especially for a woman with excess belly fat or an abdomen that has been stretched out by pregnancy. You end up with a "tummy tuck" as a fringe benefit of surgery. Also, abdominal tissue feels most like a natural breast to anyone touching you. For you, the new breast will have little, if any, sensation.

The TRAM is not for everyone. It's NOT a good choice for:

• thin women who don't have enough abdominal tissue
• women who smoke and therefore have blood vessels that are narrow and less flexible
• women who have multiple surgical scars on the abdomen (normal Cesarean-section scars are not usually a problem)

How does TRAM work?

TRAM Flap breast reconstruction - in process

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TRAM Flap breast reconstruction - lines of incisio

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An oval section of skin, fat, and muscle is taken from the lower half of the abdomen and slid up through a tunnel under the skin to the breast area. Blood vessels remain attached whenever it's possible. The tissue is shaped into a natural-looking breast and sewn into place. If blood vessels have been cut, the surgeon reattaches them to blood vessels in the chest area using a microscope to sew the tiny, delicate attachments. The procedure takes about three hours. The new breast can also be made larger during this surgery, with an implant underneath your own tissue.

TRAM for a double mastectomy

When reconstruction is performed after a double mastectomy, a single piece of tissue (skin, muscle, and fat) is removed from the abdomen. Your doctor must determine if there is enough excess tissue to do both breasts. The flap is divided in half, and each half is placed in position, in paired openings on the chest. This surgery takes twice as long as a single reconstruction (about six hours) and the recovery time can be difficult. Women report that double reconstruction feels like you've been in a major car accident with serious abdominal injuries—in other words, be prepared to spend a few weeks feeling lousy.

Things to keep in mind about TRAM

TRAM Flap breast reconstruction - preparation

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Most women are pleased to have a flat belly from the tummy tuck that goes along with the TRAM procedure. Here are some things to think about as you consider TRAM:

• Long scar: The tummy tuck incision runs across your body from hipbone to hipbone, midway between the top of your pubic hair and your navel.
• Navel distortion: Your surgeon may need to build you a new belly button because after the abdominal area is reshaped, your natural navel may be stretched, distorted, or in the wrong place.
• Loss of feeling: Abdominal tissue feels very close to breast tissue for the toucher. However, because nerves are cut in the course of the surgery, you are not likely to have much feeling or sensitivity in your new breasts.
• Once is all you get: A surgeon can take tissue from your abdomen only once. If you used the abdominal flap for a single breast mastectomy, and later you need a mastectomy of the second breast, transplant tissue must come from the side of your back, or you'll rely on an implant.