THE TRAM FLAP BREAST RECONSTRUCTION
The TRAM flap was developed more than 20 years ago, and was a great advance in reconstruction of the breast after cancer. New microsurgical techniques like the TUG, DIEP and SIEA flap have supplanted it and should relegate TRAM use to rare circumstancesz. There are two basic types of TRAM flap, the pedicled TRAM, and the free TRAM.
THE PEDICLED TRAM RECONSTRUCTION
The pedicled TRAM flap does not require the use of microsurgery. The tissue tends to be less reliable, requires a larger abdominal dissection, and a contour irregularity of the chest and abdominal wall is often present below the reconstructed breast.
The abdominal tissue used in TRAM breast reconstruction is shown on the left above (A). The paired rectus abdominus muscles are pictured. The abdominal tissue is harvested with the rectus muscle and placed through a tunnel under the skin and fat into the defect made by the mastectomy (figure B). The muscle used for the reconstruction loses its function. The defect resulting from muscle and fascia loss is repaired with suture or possibly mesh. Because it is under tension, the repair sometimes weakens and can lead to hernia formation or bulging.