Ask Dr. Elliott: Should I Choose a TRAM Flap for My Breast Reconstruction?

A breast cancer diagnosis can be overwhelming to say the least, let alone when you factor in all the decisions which need to be made in its wake. As a board-certified plastic surgeon who specializes in breast reconstruction, one of my goals is to make life a little easier for current breast cancer patients and survivors alike who are considering reconstructive surgery after a mastectomy or lumpectomy. One of the ways I’m happy to help is by offering accurate and straightforward information you can use to decide which method of reconstruction is best for you. There are more possibilities than most patients initially realize, from breast implants to your own natural tissue to a combination of both. Today, we’ll take a closer look at the TRAM flap – a type of breast reconstruction which uses a “flap” of muscle, fat, and sometimes skin from your abdominal area and “re-routes” it to the chest in order to form a new breast. So how do you know if the TRAM flap is the right choice for you?

A TRAM flap breast reconstruction may be ideal for patients who…

• Would benefit from a tummy tuck-like result in their abdomen.
• Want to use their own natural tissue (as opposed to a breast implant) without the increased risk and operating time of the DIEP flap. The DIEP flap is another reconstruction procedure which uses abdominal fat, skin, and blood vessels to re-create the breast. But instead of using muscle as the blood supply to nourish the fat cells, a DIEP flap uses specific blood vessels instead, so it requires microsurgery to connect these vessels. As a result, the surgery often takes around five hours or even longer depending on the surgeon’s experience (compared to a three-hour TRAM flap), which can mean a higher risk of complications.
• Want a more natural-looking result compared to breast implants.
• Do not have enough healthy tissue remaining on their chest after a mastectomy to accommodate an implant.
• Have had a unilateral mastectomy (only one breast removed) and are concerned about their reconstructed breast looking symmetrical to their natural one.
• Want their results to remain natural-looking over time. TRAM flap reconstructed breasts will age in a similar way to natural breasts, while implants tend to retain more of their original shape.

A patient may want to consider other breast reconstruction options if…

• They don’t have access to a surgeon who is skilled in TRAM flap surgery. The procedure is more dependent on the surgeon’s skill than a breast implant is. I was fortunate enough to work alongside Dr. Carl Hartrampf, the surgeon who developed the TRAM flap breast reconstruction method, and have been performing and perfecting the surgery since 1983. However, if you don’t have access to a surgeon who is highly experienced in the TRAM flap, you may want to consider other options.
• They have a medical condition which makes it unsafe for them to be under anesthesia for the few hours a TRAM flap (or any reconstruction using your own tissue) requires.
• They want their surgery and the recovery period to be shorter, which is typically the case with breast implants.
• They’re concerned about having an additional scar in the lower abdomen where the tissue is taken from to re-create the breast.
• They have a history of smoking or circulatory problems. This makes certain complications more likely in TRAM flap reconstruction (and any other type of reconstruction using your own tissue).

While using information like this to educate yourself about your options is a great start, every patient is unique, and selecting a breast reconstruction procedure is a complex decision. That’s why it’s so important to visit a board-certified plastic surgeon for a personal consultation. During this appointment, I’ll be able to perform an initial exam, discuss your medical history, and begin working with you to design a surgical plan that’s best for you and your needs. If you’re ready to take this step, schedule a consultation with me, Dr. Franklyn Elliott. Or, for more helpful information about breast reconstruction and other plastic surgeries, follow me on Facebook, Twitter, and Google+.