What is a TRAM Flap?

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  • Written By: Autumn Rivers
  • Edited By: Andrew Jones
  • Last Modified Date: 14 October 2018
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A TRAM flap procedure is a type of reconstructive breast surgery in which some fat, muscle, and skin are taken from the abdomen and relocated to the chest. Though this procedure often leaves patients with decreased abdominal strength, it usually also results in a tummy tuck since fat is removed, thereby inspiring mixed reviews among patients. The two types of TRAM flap surgery are the pedicled method, in which the tissue stays attached to the original blood supply, and the free procedure, which requires the tissue to be detached from the blood supply and relocated to the chest. Since the TRAM flap procedure involves incisions in both the chest and stomach, there are usually two scars left behind.

Some women opt for the TRAM flap procedure over breast implants since it does not involve any foreign material entering the body. Not only is it considered a more natural type of breast surgery, but it also usually results in breasts that feel less fake than implants usually do. Additionally, the patient gets to have a tummy tuck since fat is usually removed from the stomach to be placed in the chest area, leaving behind a flatter stomach. Of course, the downsides include two scars, a weakened stomach due to decreased muscle, and the need to recover from surgery on two parts of the body.


In a pedicled TRAM flap procedure, a skin flap is created in the lower abdomen, and remains partially attached to the abdominal muscles. Its blood supply is the superior epigastric muscle, which it stays attached to as the flap gets tunneled under the chest skin until it sits in the breast area. Though the flap stays attached to its blood supply, there are sometimes problems with the reliability of it, since the flap's new location is so far from the artery.

On the other hand, the free TRAM flap procedure involves detaching the flap from its blood supply, and then reattaching it on the chest. Therefore, the tissue is not tunneled under the chest skin, and once the flap is in its new location, it is attached to blood vessels in the underarm. While the blood supply is more reliable with this method, the newly connected blood vessels could clot or become detached, which is why an exceptionally experienced surgeon is typically necessary for this surgery. When performed properly, this type of TRAM flap procedure has fewer complications than the pedicled type.



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