Transverse Rectus Abdominus Myocutaneous (TRAM) Flap

The third option for reconstruction is the transverse rectus abdominus myocutaneous flap or TRAM flap. There are several variations of this flap: the pedicle tram, free tram, and DEIP flap. All three utilize the lower abdomen to create a breast mound. The advantages of this procedure are that a permanent implant is usually not required and postoperative radiation treatment, while again not ideal, is possible. The disadvantages of this procedure are that it results in a large abdominal scar, portions of the flap can become hard and may result in lower abdominal weakness and possible hernia formation. In addition, the procedure takes approximately 3-4 additional hours of surgery. Most commonly a patient stays 2-3 days in the hospital and is off work 3-4 weeks post surgery.