Free TRAM (Transverse Rectus Abdominis Muscle) Flap
As with the DIEP flap, skin and fat from the abdomen which is normally removed during an abdominoplasty (tummy tuck) is used to reconstruct the breast. However, some or all of the rectus abdominus (belly “six pack”) muscle is taken with the flap around the artery and vein. The vessels are reconnected in the chest like with the DIEP flap.
The resulting breast reconstruction is similar to a DIEP flap reconstruction. The advantage is an easier and sometimes faster surgery in the hands of many surgeons at the cost of sacrificing of some of the abdominal muscle resulting in a higher risk of postoperative abdominal difficulties and pain. Even muscle-sparing free TRAM flaps, designed to take less muscle, still may have a greater impact on the abdominal wall than DIEP (muscle sparing) flaps.
In a small number of situations in which a DIEP flap may not provide adequate perfusion to the flap, a free TRAM may be used instead. This usually occurs in cases such as when previous surgeries or scarring have damaged the key DIEP flap perforator vessels.
Many surgeons perform more free TRAM flaps than DIEP flaps. When checking the credentials of your reconstructive surgeon, it is very important to ask them directly how many DIEP flaps are converted to free TRAM flaps in their practice. Dr. Granzow is forced to convert less than 5% of DIEP flap procedures to muscle-sparing free TRAM procedures.
Pedicled TRAM Flap
Musculocutaneous flaps such as TRAM flaps are older techniques often used in breast reconstruction to rebuild a breast after mastectomy by surgeons not trained in microsurgery. This type of flap remains "tethered" to its original blood supply.
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