Transverse rectus abdominus myocutaneous (tram) flap breast reconstruction

Involves rebuilding a breast shape by moving skin, fatty tissue and part of the rectus abdominus muscle from the abdomen (stomach) to the chest.

​One of the benefits of a TRAM flap breast reconstruction is that the breast(s) can be reconstructed without needing implants. Some women also consider it a ‘bonus’ that the tummy is left relatively flat after removing the tissue flap (a ‘tummy tuck’ effect).

A TRAM flap breast reconstruction may NOT be the best option if you:

  • have had surgery to the abdomen in the past; the similar DIEP flap or other tissue flaps may be suitable alternatives
  • have poor blood flow through blood vessels
  • have chronic medical conditions (such as some severe respiratory or circulatory problems)
  • are very slender (because there may not be enough abdominal tissue for this procedure).

Breast reconstruction techniques which use tissue flaps that rely on a supply of blood may not be suitable for people who smoke. Smokers should stop cigarette smoking and nicotine substitutes for at least 4 weeks before the scheduled operation. This may be a consideration when deciding whether immediate or delayed breast reconstruction would be best for you.

​Nipple and areola reconstruction

If the nipple and areola are removed during mastectomy, they can be recreated. For some women this is important and completes the look of their reconstructed breast(s). Other women decide that it is not necessary.

Nipple and areola reconstruction is usually done at least 3 months after breast reconstruction surgery. This gives time for the reconstructed breast(s) to ‘settle’ (they may fall slightly over time). Often the nipple is reconstructed first, followed by the areola a couple of months later.

​Options for reconstructing nipples include:

  • medical tattooing to create a flat circle on the skin that is the colour of a nipple
  • using skin and tissue from the tissue of the reconstructed breast(s) to create a raised nipple
  • taking a small skin graft from the end of a reconstruction scar (usually from the abdomen or back) to create a raised nipple.  Reconstructed nipples will not feel and behave as they did before mastectomy. Nipple sensation will not be the same and there may not be any feeling in the nipple at all. Reconstructed nipples will not change size with changes in temperature.

Options for reconstructing areolas include:

  • medical areola tattooing: this is usually done a couple of months after the reconstructed nipple(s) have had time to heal and is usually done in an outpatient setting
  • transferring skin from the groin area, where the skin colour is like that of an areola.

If you would like to know more about breast reconstruction, or to request a consultation, please contact us today.