A breast formed from autologous (your own) tissue can feel to the touch, look, and move like a real breast. For these reasons, autologous tissue provides the highest quality breast reconstruction currently available.
- Cardiac disease (ie, myocardial infarction, angina, congestive heart failure)
- Pulmonary disease (ie, emphysema, chronic obstructive pulmonary disease)
- History of pulmonary embolus or deep venous thrombosis
- Collagen-vascular disease, lupus, scleroderma, polyarteritis, (small vessel disease)
- Unstable psychiatric disease
- Obesity (>25% ideal body weight)
- Older patient (physiologic age older than 70 yr)
- Cigarette smoking; unwilling to quit
- Previous abdominal surgery that has interrupted blood supply to the TRAM flap
- Although not an absolute contraindication, advise patients who wish to have more children to consider another method of reconstruction.
- Patients who desire no or little muscle to be removed with the TRAM flap should consider a free TRAM or deep inferior epigastric perforator [DIEP] flap.
More than one procedure is required for a successful TRAM flap breast reconstruction.
Stage I - TRAM flap
- An uncomplicated TRAM flap requires 4-5 days of hospitalization.
- Ambulation begins on the first postoperative day.
- To remove tension on the abdominal closure, place the patient in a flexed position at the waist for the first few days (consider use of a walker as it aids in "reinforcing" the flexed position). Begin to allow a more upright position by the end of the first week.
- Drain tubes are necessary and are usually in place for 1-2 weeks. You will go home with them and have them removed in the doctor's office at a postop visit.
- Patients require 6 weeks to 2 months to regain their energy level and resume normal activities. You (the patient) should keep this in mind when planning your return to work or activities (family reunions, holidays, etc).
- Begin full range-of-motion exercises for the shoulder at 10-14 days postoperatively. Limited range will be allowed initially, so that the flap is not disturbed.
- Patients may resume abdominal exercises in 8 weeks.
- Anesthesia (decreased skin sensation) of the mastectomy site and central abdominal skin resolves over the next 6-12 months. The degree of sensory reinnervation to the TRAM flap is variable and patient dependent.
- Because of the tight closure of the underlying muscle fascia of the abdomen, most patients experience a painless tight feeling for many months.
- Patients with preexisting back pain may have an exacerbation of this pain from the procedure and may want to consider an alternative method of reconstruction (eg, implant reconstruction).
- Prolonged convalescence and discomfort coupled with a cancer diagnosis may be depressing and emotionally draining.
- Fat necrosis and/or partial flap loss (5-15% of patients)
- Complete loss of TRAM tissue ( <1% of patients)
- Seroma (fluid collection, usually in abdominal donor site)
- Hematoma (bleeding at either chest or abdomen)
- Hernia (1-5% of patients)
- Abdominal bulge without hernia (5-15% of patients)
- Deep venous thrombosis and/or pulmonary embolus ( <1% of patients)
- Death ( <1% of patients)
WebMD Video on free TRAM flap reconstruction.
Breast Reconstruction: TRAM, Unipedicled by Michael R Zenn MD--eMedicine Article
Breast Reconstruction--American Society of Plastic Surgeons
Breast Reconstruction--Medline Plus
Breast Reconstruction After Mastectomy--American Cancer Society
Breast Reconstruction after Mastectomy--Mayo Clinic
Breast Reconstruction Guide for Patients by Stephen S. Kroll, M.D.
Reoperative Plastic Surgery of the Breast by Kenneth C. Shestak, MD; Lippincott Williams & Wilkins, December 2005