Following its removal from the abdomen, the tissue is transferred to the mastectomy site. The views expressed in Ask a Surgeon and the Patient Community are those of the participants and do not necessarily reflect the opinions of the American Society of Plastic Surgeons. Woman after mastectomy: showing TRAM and surrounding tissues in preparation for breast reconstruction. Your plastic surgeon may discuss the pros and cons of surgery on your opposite breast, even if it's healthy, so that it more closely matches the shape and size of your reconstructed breast. Drains placed in the breast and donor area of the abdomen stay in place for two to three weeks while the patient recovers at home, and are taken out during an office visit. Abdomen (DIEP flap). Breast reconstruction with flap surgery involves taking a section of tissue from one area of your body most often your abdomen and relocating it to create a new breast mound. The good news, is that you can have breast reconstruction surgery. It creates a natural-looking breast. TRAM flap proceduresuse the tissue from a woman's abdomen to create a mound to reconstruct the breast. First, taking some of the six-pack muscle away results in a weakened abdomen. The main concern about the free TRAM procedure is that the reconstruction depends upon the newly attached blood vessels to the flap tissue. 1998-2022 Mayo Foundation for Medical Education and Research (MFMER). The TRAM Flap is one of the most common techniques used for reconstruction of the breast after mastectomy. Having less core strength is a significant drawback of the technique. Your surgeon determines which method is best for you based on your body type and your medical and surgical history. They'll probably be absorbable sutures, though, so you won't need to have them removed. Pedicled TRAM flap reconstruction moves skin, fat, and muscle from the abdomen to recreate the breasts. A TRAM flap uses donor muscle, fat and skin from a woman's lower abdomen to reconstruct the breast. Tissue from the abdominal wall (tummy) can also be used as a pedicle flap (transverse rectus abdominis muscle or TRAM flap). The surgery's tongue-twister of a name comes from the branches of the primary blood vessel relocated during the procedure, the deep inferior epigastric perforator (DIEP). The most common type of autogeneous tissue (from one's own body) reconstruction is the pedicled transverse rectus abdominus myocutaneous (TRAM) flap. TRAM flap is short for transverse rectus abdominis myocutaneous flap. A breast mound is created that comes as close as possible to the shape and look of a natural breast. The muscle is left attached to the ribcage above and the muscle is divided below. or share your journey with other people just like you on the Patient Community. Transaxillary incision: An incision made in the underarm area. Prolonged time in surgery and under anesthesia, Tissue death (necrosis) due to insufficient blood supply, Loss of sensation at the tissue donor site, Help your breasts look natural under clothing or a bathing suit, Help you avoid the need for using a form (external prosthesis) inside your bra, Partially erase the physical reminders of your disease, Require additional surgery to correct reconstructive problems, Give your reconstructed breast the same sensations as your normal breast. Keep your expectations realistic about your surgery. The TRAM flap procedure is the right fit for some patients, but it is important that your choice takes into consideration your body type, health, lifestyle, and personal reconstruction goals. Breast Reconstruction Using TRAM Flap / Free TRAM Case #5. The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons. breast reconstruction surgery (DIEP or TRAM flap) Information for patients. If these fail, then there can be "flap death," and the new breast will be lost. . In either case, a TRAM flap breast reconstruction uses natural tissue taken from the patient's own body, rather than artificial silicone breast implants, and can provide the benefits of an abdominoplasty, or tummy tuck, in addition to natural-looking breast reconstruction results. Flap reconstruction requires specialized training in reconstructive microsurgery, which not all breast surgeons have. https://www.uptodate.com/contents/search. Stay Informed. This content does not have an Arabic version. The recovery from a TRAM flap procedure is also far more intensive. Breast reconstruction following the removal of the breasts, most commonly due to breast cancer, is a complex plastic surgery procedure. If you smoke, you may be asked to quit for four to six weeks before your surgery. have had surgery to the abdomen in the past; the similar, have poor blood flow through blood vessels, have chronic medical conditions (such as some severe respiratory or circulatory problems). The surgeon will be able to identify donor sites that will work for your body. The different types of flaps from your abdomen that may be used to re-create a breast mound are listed below: Pedicled Transverse Rectus Abdominis Myocutaneous (TRAM): this flap is rotated on its blood supply and consists of skin, fatty tissue and muscle, with or without fascia. Breast reconstruction is the surgical process of rebuilding the shape and look of a breast, most commonly in women who have had surgery to treat breast cancer. Breast reconstruction is a surgical procedure that restores shape to your breast after a mastectomy surgery that removes your breast to treat or prevent breast cancer. When the skin-sparing mastectomy is finished, all of the breast skin (except the nipple and . Because adequate blood supply is critical to the survival of transplanted tissue in flap surgery, your surgeon may prefer not to perform a pedicled flap procedure if you're a smoker or if you have diabetes, vascular disease or a connective tissue disorder. A newer procedure, deep inferior epigastric perforator (DIEP) flap, is similar to an msTRAM flap, but only skin and fat are removed. . Delayed breast reconstruction is considered more challenging than immediate reconstruction. 2022 Your doctor can prescribe medication to control your pain. If you've had only one breast reconstructed, you'll need to have screening mammography done regularly on your other breast. Originally developed in the 1980's by Dr. Carl R. Hartrampf, a TRAM flap procedure involves moving a small amount of the patient's abdominal tissue, including fat and muscle, to the chest, where it can then be used to rebuild the breast mound. Depending on the size and condition of the blood vessels, they will perform one of the following procedures. The creation of a new breast can dramatically improve your self-image, self-confidence and quality of life. This is not a microsurgical procedure. Using complex microsurgical techniques, the blood vessels are attached to the ones in your chest and the skin and fat are used to create a breast. TRAM Flap Breast Reconstruction TRAM flap (transverse rectus abdominis muscle flap) involves reconstructing the breast using tissue and muscle from the lower abdomen. Learn more about DIEP breast reconstruction. Conversely, a "muscle-sparing" free TRAM flap uses a smaller portion of the rectus muscle, so women tend to recover more quickly and have a lower risk of losing abdominal muscle strength. You may be interested in the final touches of either nipple reconstruction or 3D nipple tattooing. This study describes the experience of radical mastectomies with simultaneous breast reconstruction using TRAM flap in patients with inflammatory breast cancer. TRAM (transverse rectus abdominus muscle) flap procedure harvests abdominal tissue. Some women may experience a change in breast sensation after breast reconstruction surgery, and some scarring at the incision sites will occur. The hospital stay is anywhere between 3 to 5 . This is a similar risk taken during DIEP flap. A pedicled TRAM is usually a less intricate procedure, requiring less time in surgery. Clinical Breast Cancer. Autologous tissue breast reconstruction uses one of two surgical methods: In a pedicle TRAM flap procedure, the surgeon cuts a section of skin, muscle, fat and blood vessels from your abdomen, tunnels the tissue underneath your skin to its new location, and uses it to form a new breast mound. If you would like an interpreter to help you understand any information on this website, please call TIS National on 131 450 and ask them to call Cancer Australia on 02 9357 9400. Flap reconstruction. You'll also have stitches (sutures) after your surgery. Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. In the transverse rectus abdominis musculocutaneous (TRAM) flap procedure, a portion of the abdominal wall is transposed to the chest as a pedicle or free flap. A new technique for breast reconstruction, autologous fat grafting, uses liposuction to gather fat tissue from your thighs, abdomen or buttocks to reconstruct the breast or to improve the appearance of your breast after reconstruction. But this has been largely replaced by its . for Breast reconstruction with flap surgery, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Sign up for Email: Get Your Free Resource Coping with Cancer, Common questions about breast cancer treatment, Infographic: Breast Reconstruction Options, 3D tattooing replicates skin tone after breast reconstruction. TRAM Flap (Abdominal Muscle) Breast Reconstruction. A pedicled TRAM flap uses your whole rectus muscle one of the four major muscles in your abdomen. One common flap procedure is known as TRAM, or traverse rectus abdominal muscle, flap reconstruction. Before surgery, follow your doctor's instructions on preparing for the procedure. Your plastic surgeon will describe your surgical options and may show you photos of women who have had different types of breast reconstruction. Some women also consider it a bonus that the tummy is left relatively flat after removing the tissue flap (a tummy tuck effect). During a deep inferior epigastric perforator (DIEP) flap procedure, the surgeon removes a section of abdominal skin and fat, along with the associated blood vessels. The fat, blood and rectus abdominus are pulled through a tunnel that is created under the skin to form a breast mound or a pocket for a breast implant. TRAM flap: Also known as transverse rectus abdominus myocutaneous flap, a surgical technique that uses muscle, fat and skin from your own abdomen to reconstruct the breast. Guest over a year ago. Breast reconstruction may also entail reconstruction of your nipple, if you choose, including tattooing to define the dark area of skin surrounding your nipple (areola). Breast reconstruction with flap surgery is a complex procedure performed by a plastic surgeon. The views expressed in Ask a Surgeon and the Patient Community are those of the Unlike in DIEP flap, TRAM flap procedures can potentially have a negative effect the muscle wall in the abdomen because a section of the muscle is taken away. Although the pedicled TRAM flap donor area reinforced with mesh results in decreased rates of postoperative abdominal bulging and hernias, the best technique to accomplish that is yet to be elucidated. National Cancer Institute. If you don't have excess abdominal tissue or you've had abdominal surgery in the past, you may not be a candidate for a TRAM flap reconstruction. You will want to explore all reconstruction options, before making a decision. For a muscle-sparing free TRAM flap, your surgeon takes only a portion of your rectus abdominis muscle, which may help you retain abdominal strength after surgery. For more information about these cookies and the data Photo prior to nipple and areola reconstruction. Tissue from your back or less commonly your buttocks may also be used. The 2 most common types of tissue flap procedures are the TRAM flap (or transverse rectus abdominis muscle flap), which uses tissue from the lower tummy area . Advantages of using TRAM flaps are: Consistency of the reconstructed breast. Breast reconstruction- Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Staged reconstruction of right breast delayed after mastectomy with TRAM Flap. Cancer Australia was established by the Australian Government in 2006 to benefit all Australians affected by cancer, and their families and carers. Free TRAM flap Your surgeon will cut a flap that includes your abdominal muscle on one side . This muscle is elevated off the back with skin, fat, and attached blood vessels (thoracodorsal artery and vein) and transferred through the armpit into the breast pocket. This content does not have an English version. This may help you become familiar with the changes to your breast after surgery so that you can be alert to any new changes and report those to your doctor. You may also choose to perform breast self-exams on your natural breast and the skin and surrounding area of your reconstructed breast.

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