Pedicled TRAM (Transverse Rectus Abdominis Muscle) Flap
Like the other flaps, the abdominal skin and fat is used for breast reconstruction. However, almost the entire rectus abdominus muscle (belly “six pack”) on one side is taken around the blood vessels to preserve them. The muscle is turned or folded on itself and the flap is passed under the chest wall skin up into the chest to provide blood flow for the new flap.
This flap does not require microsurgical expertise or training and is therefore widely used. Also, it is therefore usually quicker to perform. It may be used as a second-line procedure in abdominal breast reconstruction cases where the inferior blood vessels to the abdominal tissue have been damaged or divided, such as by previous surgery.
However, significant complications include a higher risk of abdominal weakness and hernia (especially if done on both sides for reconstruction of both breasts) and higher rates of fat necrosis which cause lumps or masses in the reconstructed breast.
Some physicians are proponents of a “muscle sparing” pedicled TRAM, used in an effort to decrease the abdominal risks associated with the procedure. This may or may not lessen the chances of later abdominal difficulties.
This flap typically has a less favorable blood supply when compared to the free flaps described above, and less abdominal skin and fat often can be utilized.
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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