Autologous tissue breast reconstruction uses the patient’s own tissue to recreate a breast mound. Reconstruction using your own abdominal tissue generally results in a natural feel and look; your new breast is integrated into the body and respons to changes in your body weight, as would your natural breast. This method of reconstruction can generally achieve a more durable and natural-appearing result than reconstruction based on prosthetic implants alone, and complete restoration of the breast mound in a single stage is possible in most patients. There is now a large array of choices for autologous tissue breast reconstruction, including the TRAM flap (pedicled transverse rectus abdominus myocutaneous flap).
There are two major ways in which the abdominal tissue can be transferred to the chest to build a breast: pedicled (tunneled) or free (completely removed and then microsurgically reattached). Although both methods result in similar breast and abdominal scars, there are some major differences between them. TRAM flap breast reconstruction involves rebuilding a breast shape by moving skin, fatty tissue and part of the rectus abdominus muscle from the abdomen to the chest. The flap is left attached to the blood supply (this attached part of the flap is called a ‘pedicle’).
One of the benefits of a TRAM flap breast reconstruction is that the breast can be reconstructed without needing implants. Some women also like that the stomach is left relatively flat after removing the tissue flap, providing a tummy tuck like effect. When your abdomen is used as the donor tissue for breast reconstruction, the scar will extend from side to side at the level of your pubic hairline. This scar is usually slightly higher than the scar from a cosmetic tummy tuck. Although this method will remove excess skin and fat from your abdomen, it will not make your abdomen completely flat.
Recovery from the abdominal flap reconstruction can take 6 to 8 weeks. While most of the physical discomfort subsides within the first two weeks, it is not uncommon to experience fullness, tightness, or numbness. These symptoms will improve over time, but require patience as it can take up to 12 months for these feelings to resolve.
In a small percentage of women, especially those requiring both breasts to be reconstructed, there is an increased risk of abdominal hernia and bulge formation following the abdominal flap procedure. This risk is higher for the TRAM flap than for the DIEP flap procedure, in which all the abdominal muscle is usually left intact.
A TRAM flap breast reconstruction might not be suitable for you if you have poor blood flow through your blood vessels, have very little abdominal tissue or if you have had surgery to the abdomen in the past; implants or other tissue flaps may be suitable alternatives.