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Free TRAM Flap

The free TRAM flap (short for transverse rectus abdominis myocutaneous flap) is a procedure that rebuilds one or both breasts using abdominal skin, a small amount of muscle and fat. By sparing most of the abdominal muscle, free TRAM flap reconstruction leads to quicker recovery times and an increased ability to maintain abdominal muscle strength compared to the pedicled TRAM flap.

Free TRAM flap reconstruction is typically performed by surgeons, operating room teams and hospitals that have significant experience with a technique called microsurgery. Surgeons use microscopes and other special tools to connect blood vessels and maintain blood flow in the tranferred tissue.

Most patients are candidates for the free TRAM flap since it can be performed not only in patients of normal weight but also in those who are overweight and moderately obese. It also may be an option for patients who have undergone previous abdominal surgery. Microvascular surgery alternatives include the DIEP flapSIEA flap or TUG flap. When microsurgery is not an option, alternatives include the latissimus flap or pedicled TRAM flap.

Free TRAM flap reconstruction is performed under general anesthesia and takes four to six hours for one breast and seven to 10 hours for both breasts. Patients are hospitalized for four to eight days and can return to work within four to eight weeks.

Common side effects include bruising and swelling. Several temporary drain tubes remain in place after surgery. Surgeons monitor blood flow carefully. Return trips to the operating room may be necessary to restore blood flow. Delayed wound healing occasionally occurs. Flap failure is uncommon.

Listen to a physician explain differences between the DIEP flap and TRAM flaps.