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Breast reconstruction plastic surgery
To get answers to the most frequent questions about breast reconstruction
plastic surgery, the TRAM flap technique, and the types of TRAM
flaps, please select one of the links below:
My surgeon plans to do a "muscle sparing"
procedure with my TRAM flap -- what does this mean?
In an effort to maintain abdominal tone and limit problems in
the area of flap harvest on the abdomen, techniques have been
developed which leave behind a portion of the rectus muscle after
the TRAM flap is transferred to the breast.
The safety and effectiveness of this "muscle sparing"
is not yet fully established since the nerve supply to the abdominal
muscles is interrupted with every technique.
How much time will I spend in the hospital
after my TRAM flap?
As with most surgical procedures, length of hospital stay following
TRAM flap reconstruction has decreased in recent years. Currently,
our patients usually are discharged on the 3rd - 6th day following
the procedure.
When can I resume normal activities following
a TRAM flap?
Length of time will vary slightly from patient to patient, but
most women return to unrestricted activity within three weeks
following TRAM flap reconstruction.
The abdomen will feel tight for weeks to months, and a small
bulge (the rotation point of the rectus muscle) will be present
in the upper abdominal area for several months as well. Every
time innervated, contracting muscle tissue is removed from an
area where there is no other muscle available to assume the same
function, there will be a noticeable effect on that area of the
body.
In the case of taking the rectus muscle from the abdomen, there
is a 5 by 7 cm area at the lower aspect of the muscle where the
rectus muscle is the most important structure preventing bulging
of the tissues.
Unfortunately even if the muscle is replaced with mesh, the mesh
is a static structure that will not contract to prevent slight
bulging when sitting up, coughing or straining.
Will drains be used after a TRAM flap?
Following a TRAM flap, there will be surgical drains in the mastectomy
wound as well as in the abdominal wound which will be present
for up to 10 days and which limit personal hygiene to sponge baths
only.
What is a "free" TRAM flap?
A "free" TRAM flap is a technical
variation of the pedicled TRAM flap in which the skin, fat and
muscle tissue which are used to reconstruct the breast are completely
detached from their donor area on the abdomen and reattached
to the chest wall using microsurgery.
What are the advantages of a "free"
TRAM flap?
The choice of the "free" TRAM flap is largely a matter
of surgeon preference although less muscle and fascial dissection
are some advantages of the free TRAM flap.
There is also no need for a tunnel beneath the skin, which may
be a short term advantage for the free TRAM flap, and in some
cases it will allow for better definition of the inframammary
fold, but this advantage will not affect the shape of the reconstructed
breast on a long term basis.
There may be situations in which a free TRAM flap can be used
where a "pedicled" flap could not, and the free TRAM
may be better suited to some higher risk patients.
Some surgeons believe the free TRAM flap offers an advantage
in the young, thin, athletic patient since more tissue can be
safely transposed with a free flap than with a pedicled flap.
The use of the free TRAM could allow immediate reconstruction
in some cases (i.e. patients who smoke or who are overweight)
in which pedicled techniques would not be indicated. The use of
free tissue, however, does not minimize the significant risks
at the donor site and general medical problems in smokers and
in the obese population.
What are some disadvantages of a "free"
TRAM flap?
Because the blood vessels that nourish the flap must be re-attached
using microsurgery, the free TRAM technique does result in a longer
hospital stay and an extended surgical time as well as more involved
postoperative care.
If there are problems with the blood flow in the flap, the patient
must be taken back to the operating room immediately. This occurrence
happens in about 5 - 10% of cases. If circulation cannot be reestablished,
the flap will be lost entirely, not just partially as in most
pedicled flaps that have problems with circulation.
What is a "supercharged" TRAM flap?
"Supercharged" refers to TRAM flaps that are transferred
on their rectus muscle pedicle but in addition utilize microsurgery
to provide added blood flow into the flap or venous outflow from
the flap.
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