ABDOMINAL MUSCLES AND RECONSTRUCTION
One of the main reasons women have been seeking out microsurgical breast reconstruction is because they worry about the loss of abdominal muscles with the TRAM flap. A very popular form of reconstruction, TRAM flaps have become widely available and have produced excellent aesthetic results in many women. The TRAM was a major advance in breast reconstruction when it became available. The abdominal skin and fat is soft, feels like a breast and has all the advantages of using your own tissue. The results are permanent, and there is no need to worry about implant capsule formation or the changes in appearance over time that are associated with implants and capsular contracture.
But the TRAM flap has some significant drawbacks. It requires removal of part or most of a rectus muscle and the supporting fascia of the abdominal wall. The rectus muscle provides abdominal strength and support. In bilateral TRAM flaps - used to reconstruct both breasts, function in both rectus muscles is lost, and more fascia is sacrificed. In these reconstructions, the abdominal wall may need to have synthetic mesh sewn in to help counteract the loss of supporting tissue resulting from TRAM harvest. The ability to perform a sit-up can be lost, resulting in the need to roll on your side before getting out of bed or lying down. The loss of abdominal support can also lead to hernia formation and bulging.
One of the great benefits of DIEP, SIEA and Inner thigh flap reconstruction is the preservation of the abdominal muscles and fascia. Most women become concerned when they hear the TRAM sacrifices an abdominal muscle and can result in the loss of the ability to do a sit up. And it is those women who have sought out and encouraged alternate forms of soft tissue reconstruction.