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TRAM flap

The TRAM flap was the first method utilized by plastic surgeons to reconstruct a breast with a patient's own flesh after mastectomy. It has been 22 years since the TRAM flap was first described and over that period time the procedure has been improved upon. It is the "standard of care" today to which all other methods of reconstruction in which the patient's own flesh is utilized must be measured.

The Transverse Rectus Abdominus Myocutaneous flap sacrifices one or both rectus abdominus muscles (the sit up muscles) to supply the blood flow to the overlying skin and fat that will be used to form the breast. The muscle does not contribute to the size or shape of the breast. It only contributes to its blood supply. Technically it is not the muscle that provided the blood supply, but rather the blood vessels that lie within the muscle.

The rectus abdominus muscle is one of the muscles that has a dual blood supply. There are vessels that enter the upper muscle just below the rib cage and there are vessels that enter the muscle from the groin. The flap that is utilized to make the breast is the skin and fat between the belly button and the pubic area. Logically, and correctly the blood supply to the lower abdominal skin and fat is dominantly supplied by the lower and not the upper set of blood vessels.

Flap anatomy

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