Give Plastic Surgery Group at City Centre a phone call at (778) 907-8812 Contact Us
Give Plastic Surgery Group at City Centre a phone call at (778) 907-8812 Contact Us

Types of TRAM Flap Breast Reconstruction

A TRAM flap can be done either as a Pedicled or Free TRAM flap; the primary difference between the two is how the new breast gets circulation to it.

Pedicled TRAM Flap

A pedicled TRAM means that the muscle and the blood vessels providing circulation are left attached at the base of the breast/ribcage. The muscle, fat, and skin are lifted from the abdomen and tunneled beneath the upper abdominal skin and the crease under the breast to the chest. The TRAM flap is then coned and reshaped to make a new breast. Blood flow to the transferred abdominal tissues is retained through connections between the underlying abdominal muscle tissue and the overlying abdominal skin and fat.

Free TRAM Flap

A free TRAM uses the same muscle, fat, and skin flap to make a new breast, but the blood vessels are disconnected in the abdomen and then the flap is transplanted to the chest where circulation is restored using a microscope. Both can be done at the time of mastectomy (immediate) or at a later date (delayed). See Microsurgical Breast Reconstruction for more on the Free TRAM procedure.

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When Is the TRAM Flap Breast Reconstruction Used?

This procedure can be used for patients who do not want an implant, preferring a soft, natural breast. Situations in which TRAM flap reconstruction would not be suitable include:

  • Women who have had previous abdominal surgeries
  • Women who want to become pregnant in the future
  • Lack of lower abdominal fat
  • Smoking, diabetes or obesity
  • Previous radiation to the area under the crease of the breast or need for future radiation

TRAM flaps are rarely used if both breasts need to be reconstructed (bilateral reconstruction) as the risks of complications to the abdomen rise significantly if both of the rectus muscles are used.

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Good Candidates

If you have no major medical problems aside from the diagnosis of breast cancer and you have enough of a mound of skin and fat on your lower abdomen to make a new breast, then you may be a candidate for a TRAM flap.

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Testimonials Words From Our Patients

N.G.

Had a breast reduction done by Dr Adrian Lee. Amazing surgeon - very kind, explains things well and paid close attention to detail. The staff in the office are very kind too. I am ...

Had a breast reduction done by Dr Adrian Lee. Amazing surgeon - very kind, explains things well and paid close attention to detail. The staff in the office are very kind too. I am very impressed with how the healing has gone - back pain disappeared and with how thorough he is as a surgeon I believe that’s what helped the recovery process. Would recommend him and the office to anyone. :)

R.M.

I have had two surgeries at the Plastic Surgery Group at City Centre. I have only had interaction with Laurie in reception and Dr. Prince. Dr. Prince is second to none. She takes t...

I have had two surgeries at the Plastic Surgery Group at City Centre. I have only had interaction with Laurie in reception and Dr. Prince. Dr. Prince is second to none. She takes the time to explain everything in detail and answer any and all questions. Her expertise and her skills are truly exceptional. She is very easy to talk to and truly a master of her profession. I would not hesitate to recommend her services to anyone who wants the best. Laurie was also amazing. She is very friendly, knowledgeable and helpful. Dr. Prince and Laurie are both a real credit to the Plastic Surgery Group at City Centre.

S.W.

Dr. Oxley has done two procedures removing cancer for me. The first visit I had with him was in the surgery suite. He was professional, punctual and had just the right amount of hu...

Dr. Oxley has done two procedures removing cancer for me. The first visit I had with him was in the surgery suite. He was professional, punctual and had just the right amount of humour for what was a stressful time for me. The follow up visit was on time and I was booked for a second surgery. The second surgery was again, punctual and professional with a touch of humour. I am in the process of booking a follow up to my latest surgery now. I would not hesitate to use Dr. Oxley again.

K.G.

Dr. Imran Ratanshi performed my breast reduction surgery a month ago and I feel amazing. The recovery time was unbelievable and his staff has continually checked up on me to make s...

Dr. Imran Ratanshi performed my breast reduction surgery a month ago and I feel amazing. The recovery time was unbelievable and his staff has continually checked up on me to make sure I am still doing well. I would recommend him to anyone who is considering this surgery. He is honest and very helpful, provided all of the information I needed to make decision regarding my surgery. I feel like it's one of the best decisions I have ever made for my confidence. He did an incredible job, I trust him 100% and would not hesitate to put myself into his care again. Highly, highly recommend Dr. Ratanshi and his team!

R.M.

My highest recommendation for an outstanding doctor and person: Dr. Rizwan Mian. Dr. Mian has surgically removed cancer from my skin a number of times in recent years - all basal-c...

My highest recommendation for an outstanding doctor and person: Dr. Rizwan Mian. Dr. Mian has surgically removed cancer from my skin a number of times in recent years - all basal-cell carcinoma. He has always been the ultimate professional but with a kind and gentle manner that calms any anxiety a patient might be feeling. And when my most recently removed skin tested positive for melanoma I was anxious indeed! This time it was a spot on my cheek that would require a large amount of tissue removal, a biopsy of the closest lymph node, and skin grafting, all done under general anesthesia. But I need not have worried. Dr. Mian was reassuring and amazingly skillful, the surgery was successful, the melanoma contained, and the complicated skin graft has healed so well that the incision on my face is already starting to disappear. Thank you, Dr. Mian! 

J.H.

Can’t recommend Dr Genoway enough! I was looking for a reconstructive surgeon for 5 years, had several consultations with other doctors. As soon as I met Dr Genoway, I knew I...

Can’t recommend Dr Genoway enough! I was looking for a reconstructive surgeon for 5 years, had several consultations with other doctors. As soon as I met Dr Genoway, I knew I found my doctor. She is knowledgeable, experienced, kind and caring. Dr Genoway listened to all of my concerns, gave me honest medical opinion, including to comeback in a few years as I am too young for a particular procedures. I felt comfortable and not rushed or pressured. Most importantly I felt safe and in good hands. Ended up having my postpartum reconstruction and 2 other procedures (long time dream) in one go. Recovery was fast considering the extent of the procedures. I didn’t need the prescribed pain medication at all. She just has this “light hand”. Most importantly, the results are better than expected! Natural looking, better version of me, but still me. I feel more confident and much happier in my own skin.

M.Y.

I had my breast surgery in Plastic Surgery Group. Well organized safe and the best care during my surgery. Thank you guys and wish you all the best. 

G.M.

I was a novice to surgery and the staff here were amazing - very friendly and helpful. Dr. Lee was very calm and knowledgeable and answered my questions. Breast reduction surgery w...

I was a novice to surgery and the staff here were amazing - very friendly and helpful. Dr. Lee was very calm and knowledgeable and answered my questions. Breast reduction surgery was scary to me but I have zero regrets. Barely any pain or discomfort after surgery and any back pain I had before is now gone. I walk straighter and clothes fit better. My self esteem has improved. Would recommend this office and the actual surgery to anyone considering it. It’s a game changer.

T.W.

Highly recommend Dr. Prince. Had a breast reduction Oct.20....best decision Ive ever made. Dr. Prince was so professional and helpful. Great bedside manner. If you're on the fence ...

Highly recommend Dr. Prince. Had a breast reduction Oct.20....best decision Ive ever made. Dr. Prince was so professional and helpful. Great bedside manner. If you're on the fence of having this operation, go for it!! The pain level was a 1, if that. I kept waiting for the shoe to drop and the pain to hit me, never happened. Two week post op...ready to play tennis, but will wait another week. Thank you Dr.Prince and Lori!

J.P.

Dr.Oxley has been patient and very kind throughout my procedure making my experience less stressful and much more manageable. Also his office staff are a pleasure to work with. Alw...

Dr.Oxley has been patient and very kind throughout my procedure making my experience less stressful and much more manageable. Also his office staff are a pleasure to work with. Always greeting you as you come in and happy to answer any questions and concerns over the phone or via email. I never once felt alone during this process. Overall I recommend this capable and compassionate team. You'll be in good hands.

J.H.

I am a breast cancer survivor. After my reconstruction surgery failed I was referred to Dr Imran Ratanshi. His kind demeanor and great sense of humor put me at ease immediately. I ...

I am a breast cancer survivor. After my reconstruction surgery failed I was referred to Dr Imran Ratanshi. His kind demeanor and great sense of humor put me at ease immediately. I was in a very dark place emotionally due to the appearance of my body. Dr. Ratanshi preformed a deep inferior epigastric perforator surgery and it was a complete success. I believe Dr Ratanshi saved my life! A very skilled surgeon and a wonderful man.

J.C.

Absolutely amazing Suman is amazing at her job a big thank you. Dr R Mian so professional and made me feel so comfortable. A true artist in his field. I had a breast reduction Best...

Absolutely amazing Suman is amazing at her job a big thank you. Dr R Mian so professional and made me feel so comfortable. A true artist in his field. I had a breast reduction Best think I ever did for my health. Thank you Suman worth your weight in gold. Dr Mian Life changing can't not begin to Thank you. Absolutely best experience

C.A.

I had an exceptional experience with Dr. Genoway and their team. From the initial consultation to the surgery day, I felt an unwavering sense of compassion and support. The effort ...

I had an exceptional experience with Dr. Genoway and their team. From the initial consultation to the surgery day, I felt an unwavering sense of compassion and support. The effort on their end to look after my needs put me at ease. The seamless communication and follow-up care post-surgery further solidified my trust in their expertise. I was truly impressed by the pride they take in their work, and I'm grateful for the wonderful care I received. 

Read All Testimonials
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TRAM Flap Breast Reconstruction

Advantages

  • Uses your own tissue
  • Creates soft and natural breast
  • Rejuvenates the abdomen (removes fat from abdomen similar to a tummy tuck)
  • Is easy to conceal scars
  • Brings healthy, new skin to the chest which may be necessary in patients who have skin damage from multiple previous surgery scars, radiation, or failed implant reconstruction
  • Can more easily match the shape of opposite breast than implant reconstruction
  • Once healed, chance of needing future revisional surgeries low
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Disadvantages

  • Requires longer hospitalization than implant reconstruction (3-5 days)
  • The abdomen needs to recover as well. (This requires 6-8 weeks of limited physical activity)
  • Risk of abdominal weakness or hernia (especially in bilateral TRAM reconstruction)
  • Risk of fat necrosis (firm, occasionally painful deep scars in the fat of the breast)
  • Thin patients may see bulge on the lower part of the breast where the tunnel was made
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Preparing for Surgery

You will need to get some baseline blood tests and usually meet with an anesthesia doctor prior to surgery. If you are a smoker, you should quit before surgery, as the risks of complications such as wound infections, poor wound healing, and breathing problems are significantly higher in smokers. You will be asked to stop taking all over-the-counter pain or fever medicines (except Tylenol) and blood thinners for two weeks prior to your procedure. As well, many herbal medicines can cause bleeding and so need to be stopped before surgery – these include ginkgo biloba, St. John’s Wort, and high doses of fish oil, flax seed oil, or vitamin E.

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Possible Complications

As in any surgery, risks include anesthetic reaction, infection, scarring, poor wound healing, bleeding, and seroma (fluid collection). Complications specific to this surgery are mastectomy flap necrosis (skin slough), partial flap loss, fat necrosis (firm scar lumps in the breast or abdomen), abdominal hernia or bulges, numb skin, and breast asymmetry.

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To learn more about how you may benefit from TRAM flap reconstruction or to schedule a consultation with one of our board-certified plastic surgeons, please contact our Surrey office today.

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Recovery

The chest and abdomen often ache and feel bruised for a couple of weeks. The abdomen feels tight and activities such as bending, lifting, twisting, and sitting up out of bed with the abdominal muscles are uncomfortable and should be avoided for 6-8 weeks. Your doctor will prescribe painkillers to help with the pain and antibiotics to prevent infection. You will have a drain under the breast and two in the abdomen after surgery. Your surgeon usually removes these at the office 1-2 weeks after surgery. You cannot shower as long as you have drains in place. It’s common for patients to need to keep a bandage over the incision for comfort and to collect any small bits of drainage for the first 1-2 weeks after surgery until the incisions have healed. Most sutures will be absorbable.

The exact recovery can vary considerably and often depends on your health and fitness before surgery, the extent of the surgery and cancer, whether it was an immediate or delayed reconstruction, and the need for radiation and chemotherapy after surgery. Most patients are back to doing most of their activities by six weeks, but it can take 6-12 months to fully recover after the surgery. Some women find they can return to work within a couple of weeks, though most take an extended leave to help recover physically and mentally from the cancer therapy. Nipple reconstruction and tattooing is commonly done 3-6 months later under local anesthetic. It will be 6-12 months before your breasts settle into their new shape and for the scars to become less obvious.

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Schedule a consultation with one of our surgeons and get honest guidance tailored to your aesthetic goals, right here in Surrey.

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