eMedicine Specialties > Plastic Surgery > Breast

Breast Reconstruction, Free TRAM: Multimedia

Author: Michael R Zenn, MD, FACS, Associate Professor, Division of Plastic and Reconstructive Surgery, Program Director of Plastic Surgery Residency, Duke University Medical Center
Contributor Information and Disclosures

Updated: Jul 7, 2009

Multimedia

Diagram of the blood supply to the free transvers...
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Media file 1: Diagram of the blood supply to the free transverse rectus abdominis myocutaneous (TRAM) flap. Note that the deep inferior epigastric vessels supply the flap, the primary blood supply to the lower abdomen. The shaded areas of the flap are discarded.
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Diagram of the blood supply to the free transvers...

Diagram of the blood supply to the free transverse rectus abdominis myocutaneous (TRAM) flap. Note that the deep inferior epigastric vessels supply the flap, the primary blood supply to the lower abdomen. The shaded areas of the flap are discarded.

Patient 1. This patient has small breasts and has...
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Media file 2: Patient 1. This patient has small breasts and has a small amount of abdominal tissue available. This is the perfect indication for a free transverse rectus abdominis myocutaneous (TRAM) flap to maximize the amount of tissue available for reconstruction.
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Patient 1. This patient has small breasts and has...

Patient 1. This patient has small breasts and has a small amount of abdominal tissue available. This is the perfect indication for a free transverse rectus abdominis myocutaneous (TRAM) flap to maximize the amount of tissue available for reconstruction.

Patient 1. Postoperative view. Note the natural...
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Media file 3: Patient 1. Postoperative view. Note the natural ptosis of the reconstruction and the distinct inframammary fold, not distorted by a muscle pedicle from the abdomen. The patient does not desire nipple-areolar reconstruction.
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Patient 1. Postoperative view. Note the natural...

Patient 1. Postoperative view. Note the natural ptosis of the reconstruction and the distinct inframammary fold, not distorted by a muscle pedicle from the abdomen. The patient does not desire nipple-areolar reconstruction.

Patient 2. This patient has a large opposite brea...
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Media file 4: Patient 2. This patient has a large opposite breast to match and does not desire a breast reduction. A free transverse rectus abdominis myocutaneous (TRAM) flap allows a large block of tissue to be transferred, matching the opposite breast.
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Patient 2. This patient has a large opposite brea...

Patient 2. This patient has a large opposite breast to match and does not desire a breast reduction. A free transverse rectus abdominis myocutaneous (TRAM) flap allows a large block of tissue to be transferred, matching the opposite breast.

Patient 2. Postoperative view. The breast envel...
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Media file 5: Patient 2. Postoperative view. The breast envelope has been filled with the free transverse rectus abdominis myocutaneous (TRAM) flap. Note the abdominal improvement, an added benefit of the TRAM procedure. The patient still requires nipple-areolar reconstruction.
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Patient 2. Postoperative view. The breast envel...

Patient 2. Postoperative view. The breast envelope has been filled with the free transverse rectus abdominis myocutaneous (TRAM) flap. Note the abdominal improvement, an added benefit of the TRAM procedure. The patient still requires nipple-areolar reconstruction.

Patient 3. Preoperative markings. The patient has...
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Media file 6: Patient 3. Preoperative markings. The patient has a large opposite breast and does not desire breast reduction. Note the large amount of skin that will be removed. A free transverse rectus abdominis myocutaneous (TRAM) allows a large reconstruction to match the opposite side.
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Patient 3. Preoperative markings. The patient has...

Patient 3. Preoperative markings. The patient has a large opposite breast and does not desire breast reduction. Note the large amount of skin that will be removed. A free transverse rectus abdominis myocutaneous (TRAM) allows a large reconstruction to match the opposite side.

Patient 3. Postoperative view. There is a good vo...
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Media file 7: Patient 3. Postoperative view. There is a good volume match, and the resected breast skin has been replaced with abdominal skin.
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Patient 3. Postoperative view. There is a good vo...

Patient 3. Postoperative view. There is a good volume match, and the resected breast skin has been replaced with abdominal skin.

Patient 3. Postoperative view. In this view, no...
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Media file 8: Patient 3. Postoperative view. In this view, note the natural droop of the reconstruction, unobtainable with breast implants. All of the patient's scars are below her tan lines.
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Patient 3. Postoperative view. In this view, no...

Patient 3. Postoperative view. In this view, note the natural droop of the reconstruction, unobtainable with breast implants. All of the patient's scars are below her tan lines.

More on Breast Reconstruction, Free TRAM

Overview: Breast Reconstruction, Free TRAM
Workup: Breast Reconstruction, Free TRAM
Treatment: Breast Reconstruction, Free TRAM
Multimedia: Breast Reconstruction, Free TRAM
References
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References

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  2. Hudson DA. The surgically delayed unipedicled TRAM flap for breast reconstruction. Ann Plast Surg. Mar 1996;36(3):238-42; discussion 242-5. [Medline].

  3. Lejour M, Dome M. Abdominal wall function after rectus abdominis transfer. Plast Reconstr Surg. Jun 1991;87(6):1054-68. [Medline].

  4. Schusterman MA. The free TRAM flap. Clin Plast Surg. Apr 1998;25(2):191-5. [Medline].

  5. Allen RJ. DIEP versus TRAM for breast reconstruction. Plast Reconstr Surg. Jun 2003;111(7):2478. [Medline].

  6. Nahabedian MY, Momen B, Galdino G, Manson PN. Breast Reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg. Aug 2002;110(2):466-75; discussion 476-7. [Medline].

  7. Nahabedian MY, Tsangaris T, Momen B. Breast reconstruction with the DIEP flap or the muscle-sparing (MS-2) free TRAM flap: is there a difference?. Plast Reconstr Surg. Feb 2005;115(2):436-44; discussion 445-6. [Medline].

  8. Zienowicz RJ, May JW Jr. Hernia prevention and aesthetic contouring of the abdomen following TRAM flap breast reconstruction by the use of polypropylene mesh. Plast Reconstr Surg. Nov 1995;96(6):1346-50. [Medline].

  9. Shaw WW, Orringer JS, Ko CY. The spontaneous return of sensibility in breasts reconstructed with autologous tissues. Plast Reconstr Surg. Feb 1997;99(2):394-9. [Medline].

  10. Alderman AK, Wilkins EG. Radiation therapy in postmastectomy TRAM reconstruction. Plast Reconstr Surg. Mar 2002;109(3):1199-200. [Medline].

  11. Bostwick J. Microsurgical techniques. In: Plastic and Reconstructive Breast Surgery. 2nd ed. St. Louis: Quality Medical Publishing Inc; 2000:1147-1252.

  12. Chevray PM. Breast reconstruction with superficial inferior epigastric artery flaps: a prospective comparison with TRAM and DIEP flaps. Plast Reconstr Surg. Oct 2004;114(5):1077-83; discussion 1084-5. [Medline].

  13. Grotting JC, Oslin BD. Free TRAM flap breast reconstruction. In: Spear SL. Surgery of the Breast: Principles and Art. Philadelphia, Pa: Lippincott-Raven Publishers; 1998:555-563.

  14. Lindsey JT. Integrating the DIEP and muscle-sparing (MS-2) free TRAM techniques optimizes surgical outcomes: presentation of an algorithm for microsurgical breast reconstruction based on perforator anatomy. Plast Reconstr Surg. Jan 2007;119(1):18-27. [Medline].

  15. Moon HK, Taylor GI. The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg. Nov 1988;82(5):815-32. [Medline].

  16. Slavin SA, Goldwyn RM. The midabdominal rectus abdominis myocutaneous flap: review of 236 flaps. Plast Reconstr Surg. Feb 1988;81(2):189-99. [Medline].

  17. Thoma A, Veltri K, Khuthaila D, et al. Comparison of the deep inferior epigastric perforator flap and free transverse rectus abdominis myocutaneous flap in postmastectomy reconstruction: a cost-effectiveness analysis. Plast Reconstr Surg. May 2004;113(6):1650-61. [Medline].

  18. Zenn MR. Control of breast contour by the use of Z-plasty in the irradiated breast reconstruction. Plast Reconstr Surg. Jul 2003;112(1):210-4. [Medline].

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Further Reading

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Keywords

breast reconstruction, transverse rectus abdominis myocutaneous flap, TRAM flap, autogenous tissue, free flap, microsurgery, deep inferior epigastric perforator flap, DIEP flap, superficial inferior epigastric perforator flap, SIEP flap, free-tissue transfer, TRAM flap breast reconstruction, mastectomy, chest irradiation, radiation injury, breast mount, belly tissues, breast symmetry, breast revision, nipple reconstruction, nipple tattoo, areolar tattoo

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Contributor Information and Disclosures

Author

Michael R Zenn, MD, FACS, Associate Professor, Division of Plastic and Reconstructive Surgery, Program Director of Plastic Surgery Residency, Duke University Medical Center
Michael R Zenn, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Plastic Surgeons, American College of Surgeons, American Medical Association, American Society for Reconstructive Microsurgery, American Society of Plastic Surgeons, North Carolina Medical Society, Phi Beta Kappa, Plastic Surgery Research Council, Southeastern Society of Plastic and Reconstructive Surgeons, and World Society for Reconstructive Microsurgery
Disclosure: Nothing to disclose.

Medical Editor

Pankaj Tiwari, MD, Assistant Professor, Division of Plastic Surgery, Ohio State University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Saleh M Shenaq, MD†, Former Director and Founder, The International Brachial Plexus Institute; Former Chief, Section of Plastic Surgery, Methodist Hospital, Houston
Saleh M Shenaq, MD† is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Pediatrics, American Association for Hand Surgery, American Association for the Advancement of Science, American Association of Plastic Surgeons, American Burn Association, American College of Physician Executives, American College of Surgeons, American Congress of Rehabilitation Medicine, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Gene Therapy, American Society of Law Medicine and Ethics, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Trauma Society, Association for Academic Surgery, International College of Surgeons, Lipoplasty Society of North America, Plastic Surgery Research Council, Society for Neuroscience, Society of Surgical Oncology, Southern Medical Association, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Al Aly, MD, FACS, Consulting Surgeon, Iowa City Plastic Surgery
Disclosure: Ethicon  Consulting fee Consulting; QMP Royalty Book royalty; Insorb Stapler Consulting fee Consulting; Insorb Stapler Ownership interest None; Medicis Intellectual property rights None

 
 
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