Part III: Flap-based reconstruction – TRAM
TRAM flap (Transverse Rectus Abdominis Myocutaneous) flap
The excess skin, fat, and the rectus abdominis muscle are harvested from the lower abdominal wall. There are two (2) such muscles at the midline of your abdominal wall – one of them will be utilized for the reconstruction. This flap is then raised and tunneled under the upper abdominal skin and soft tissue, to its new location at the breast area. The flap is then trimmed, shaped, and secured into place, once a pleasing breast form is created, to recreate your breast.
The TRAM flap is a completely autologous (your own tissue) reconstruction. Autologous flaps will grow with you – as you gain or lose weight, and become a part of you. Flap-based reconstructions are almost alway preferable to implant-based reconstructions in patients with a history of radiation therapy. A TRAM flap usually provides enough tissue to recreate a breast, avoiding the use of an implant.
Much like a tummy tuck, your abdominal incision will be sutured closed, first by repairing the abdominal wall, then by suturing your incision, leaving a single incision at the lower abdomen, hidden within your bikini line. To finish the closure, your umbilicus (belly button will be brought out through a small incision, and sutured at its normal anatomic location.
· Hospitalization: 3-5 days
· Advantages: Breast mound is present immediately; implant not needed – only your own tissue is used; your excess abdominal tissue is utilized; has a more natural appearance and feel of a breast
· Disadvantages: Flap complications; slightly weakened abdominal wall integrity; hernia/bulge risk; additional scar on the lower abdomen
Next…microsurgical free tissue transfers (e.g., DIEP, SIEA, GAP, etc.). This new technique for breast reconstruction will be discussed.
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