What is TRAM flap surgery?
TRAM stands for Transverse Rectus Abdominis Myocutaneous, a muscle, and tissue of the lower abdomen between the waist and pubic bone. TRAM flap surgery uses the flap (graft) from this skin, fat, and the TRAM muscles for breast reconstruction.
Advantages of using TRAM flaps are:
- Consistency of the reconstructed breast.
- No occurrence of rejection of foreign material, since the tissue used is from the patient.
- Abdominal rejuvenation.
- Improvement in the reconstructed breast, compared to implants.
Why is TRAM flap surgery done?
TRAM flap surgery is done for the following conditions:
- Patients who have undergone breast removal surgery (mastectomy) as part of breast cancer
- Asymmetrical breasts
- Previous failure from implant reconstruction
- Excess lower abdominal fat and desire for abdominoplasty along with breast reconstruction
- To maximize or preserve abdominal muscle function
- To have the maximum possible blood supply to the TRAM tissues
Who should avoid undergoing TRAM flap surgery?
This surgery should be avoided in the following conditions:
- Heart diseases
- Lung diseases, such as emphysema and COPD
- History of blood clots
- Autoimmune diseases that affect the skin, tissues and organs
- Unstable psychiatric disease
- Patients over 70
- Patients reluctant to quit smoking
- Previous multiple abdominal surgeries
- Any contraindication to the drugs, which prevent coagulation (anticoagulants)
- Patients with inadequate abdomen tissue
What is the procedure for TRAM flap surgery?
Before the procedure
- During the consultation, the patient is informed about the procedure, possible complications, and scarring.
- The patient usually will undergo lab tests, including a complete blood cell count, electrolytes, urinalysis, and blood typing.
- The patient can do abdominal exercises to strengthen their muscles before the surgery.
- The patient is given an enema the day before the surgery.
The procedure involves three stages:
During the procedure
- In the first stage, a flap (mass of tissue used for surgery) is taken from the lower half of the abdomen, shaped in the form of the breast, and used for reconstruction.
- In the next stage, the nipple is reconstructed and revised using tissues from the same breast or the opposite one.
- For the finishing process, the nipple is colorized for the natural look and the symmetry of the breast is enhanced.
After the procedure
- After the surgery, the patient requires hospitalization for three to four days with close observation for the first 24 to 48 hours.
- The patient should not exert any pressure for two months.
- The patient must wear a soft bra and should not sleep on the reconstructed breast.
- The patient requires 6 to 12 weeks to regain prior energy levels and resume normal activities.
- Exacerbation of back pain may occur.
- Anesthesia effects may still impact the patient 6 to 12 months after the surgery.
- It takes a year for the tissues to heal completely and for the scars to fade away.
What are the complications of TRAM flap surgery?
Some of the complications of TRAM flap surgery are:
- Partial or complete tissue breakdown, or death of the flap (5-15%)
- Seroma (fluid collection, usually in the abdominal donor site)
- Hematoma (bleeding at the chest or abdomen)
- A noticeable bulge in the abdomen (hernia) (1-5%)
- Abdominal bulge without hernia (5-15%)
- Deep venous thrombosis and/or pulmonary embolus (< 1%)
- Death (< 1%)
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