Body outline showing the transverse rectus abdominis muscle of the abdomen.

Breast reconstruction is surgery to recreate a breast after breast tissue has been removed as part of cancer treatment (mastectomy). There are many kinds of breast reconstruction procedures. One type is called TRAM (transverse rectus abdominis muscle). TRAM reconstruction uses tissue and muscle from your abdomen (flap procedure) to reconstruct your breast. Breast reconstruction with flap surgery is a complex procedure performed by a plastic surgeon.

There are two types of TRAM flaps:

Attached (pedicle) TRAM flap.
- Tissue and muscle stay connected to their original blood supply.
- Fat, skin, blood vessels, and muscle from your abdomen are tunneled under your skin to your chest to rebuild your breast.
Free TRAM flap.
- Abdominal tissue is disconnected from its blood supply and moved to your chest to rebuild your breast.
- Blood vessels from the flap are reconnected to the blood vessels in your chest using very precise instruments and an operating microscope (microsurgery).

Before the mastectomy, meet with a plastic surgeon who will describe your surgical options and may show you photos of women who have had different types of breast reconstruction. Your plastic surgeon may discuss the pros and cons of surgery on your opposite breast, even if it’s healthy, so that it more closely matches the shape and size of your reconstructed breast.

Your body type, health status, and cancer treatment factor into which type of reconstruction will give you the best result.

Tell a health care provider about:

Any allergies you have.
All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
Any problems you or family members have had with anesthetic medicines.
Any bleeding problems you have.
Any surgeries you have had.
Any medical conditions you have.
Any future plans to get pregnant. This procedure may not be recommended for women who want to have children.
Any history of radiation therapy to your chest.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

Pain.
Infection.
Bleeding, blood clots, or blocked blood vessels.
Loss of feeling in the breast or the place in your abdomen where muscle tissue is removed (donor site).
Bulging of an organ or tissue through a weak spot in the abdominal muscles (hernia) or abdominal weakness.
A breast that looks or feels different than expected. There may be lumps in the reconstructed breast.
Fluid collection (seroma).

Other problems associated with TRAM breast reconstruction include:

Death of the tissue flap. This would require another surgery to remove it.
If you are receiving radiation therapy after breast surgery, your health care provider may recommend waiting until you’re finished with radiation therapy before proceeding with the second stage of the breast reconstruction.

What happens before the procedure?

When to stop eating and drinking

Follow instructions from your health care provider about what you may eat and drink before your procedure. These may include:

8 hours before the procedure
- Stop eating most foods. Do not eat meat, fried foods, or fatty foods.
- Eat only light foods, such as toast or crackers.
- All liquids are okay except energy drinks and alcohol.
6 hours before the procedure
- Stop eating.
- Drink only clear liquids, such as water, clear fruit juice, black coffee, plain tea, and sports drinks.
- Do not drink energy drinks or alcohol.
2 hours before your procedure
- Stop drinking all liquids.
- You may be allowed to take medicines with small sips of water.

If you do not follow your health care provider’s instructions, your procedure may be delayed or canceled.

Medicines

Ask your health care provider about:

Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

Do not use any products that contain nicotine or tobacco before the procedure. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
Ask your health care provider:
- How your surgery site will be marked.
- What steps will be taken to help prevent infection. These steps may include:
  - Removing hair at the surgery site.
  - Washing skin with a germ-killing soap.
  - Receiving antibiotic medicine.
If you will be going home right after the procedure, plan to have a responsible adult:
- Take you home from the hospital or clinic. You will not be allowed to drive.
- Care for you for the time you are told.

What happens during the procedure?

An IV will be inserted into one of your veins.
You will be given one or both of the following:
- A medicine to help you relax (sedative).
- A medicine to make you fall asleep (general anesthetic).
Your surgeon will make an incision to remove a section of skin, fat, and supporting structures from your abdomen.
The abdominal tissue will be placed on your chest and shaped into a breast mound.
If you are having a pedicle TRAM flap procedure, your blood vessels will be checked for blood flow (patency).
If you are having a free TRAM flap procedure, your blood vessels will be reconnected with microsurgery.
Your incisions will be closed with stitches (sutures).
One or more tubes may be put in place to drain the incision sites as you heal.
Incisions will be covered with bandages (dressing) and pressure wraps.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
You will be given pain medicine as needed.
You will be encouraged to get up and walk as soon as you can.
Your IV can be removed when you are able to eat and drink.
You may have a drainage tube in place for 2–3 days. This tube prevents a collection of blood (hematoma) from developing in the breast area.
A pressure bandage may be applied for 1–2 days to prevent bleeding or swelling. Ask your health care provider how to care for your pressure bandage at home.
Keep all follow-up visits. This is important.

Summary

Breast reconstruction is surgery to recreate a breast after breast tissue has been removed as part of cancer treatment. One type of procedure to recreate a breast is called TRAM reconstruction.
Breast reconstruction is generally safe. However, some problems may occur, including pain, bleeding, infection, blocked blood vessels, death of the tissue flap, or loss of feeling in the breast or abdomen.
Before the procedure, follow instructions from your health care provider about eating and drinking restrictions and any changes to medicines and activities.
Ask your health care provider how to care for your pressure bandage or drain at home.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.

Medical knowledge, Patient Education

Abdominal Flap for Breast Reconstruction

Tell a health care provider about:

What are the risks?