tram flap breast reconstruction

The TRAM flap can be transferred as a free flap or a pedicled flap. (below) Rectus Abdominis muscle rotated up to chest Report Sexual Misconduct, Discrimination and Harassment, Alternative donor sites for breast reconstruction, Copyright 1995-2022 Regents of the University of Michigan. This is the most common method of breast reconstruction using the patients own tissue. Each technique has different advantages and disadvantages. Length of procedure: 3 to 4 hours for one breast, 5 to 6 hours for two breasts. More about Breast Reconstruction with TRAM Flap Narrow *Treatment results may vary *The member who uploaded this photo has read and agreed to the RealSelf Photo Rules This allows the surgical team to closely monitor blood flow to the newly constructed breast, ensuring that the flap is healthy. . Overall, TRAM flaps are the most commonly performed type of flap reconstruction, partly because TRAM flap tissue is very similar to breast tissue and makes a good substitute. This requires that the artery and vein which supply blood to the flap tissue to be moved as well. This is some of the same tissue that is taken during a "tummy tuck" procedure. In the TRAM procedure, the skin, fat, and muscle of the lower abdomen are used to recreate the breast. Boughey JC, et al. Within six weeks, patients may return to driving, some work (depending on job requirements) and light exercise. The study aimed to evaluate the effectiveness of primary breast reconstruction using the TRAM-flap procedure in patients with an inflammatory form of breast cancer. The plastic surgeon also provides information on anesthesia, where the operation will be performed and what kind of follow-up procedures may be necessary. Show more areas of focus for Nho (Bill) V. Tran, M.D. DIEP stands for the deep inferior epigastric perforator artery, which runs through the abdomen. In the TRAM procedure, the harvested flaps blood vessels are not severed, thereby maintaining the tissues connection to the original (belly tissue) blood supply. Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition. The flap, consisting of the skin, fat, and . Consult a plastic surgeon who's board certified and experienced in breast reconstruction following mastectomy. TRAM flap: Also known as transverse rectus abdominus myocutaneous flap, a surgical technique that uses muscle, fat and skin from your own abdomen to reconstruct the breast. It uses the lower abdominal skin, fat and rectus abdominal muscle. Tram Flap Breast Reconstruction stands for transverse rectus abdominus myocutaneous. Breast reconstruction with flap surgery is the most complex breast reconstructive option. Also the patient has the benefit of a flatter looking abdomen. Free TRAM flap Your surgeon will cut a flap that includes your abdominal muscle on one side . Flap procedures, also called autologous tissue reconstruction, which use tissue from another part of a woman's body to form a new breast Women who underwent flap procedures reported significantly greater satisfaction with their breasts, sexual well-being, and psychosocial well-being than women who underwent implant reconstruction. During a 10-year period (1991-2000) 21 women underwent TRAM reconstruction for advanced breast cancer. participants and do not necessarily reflect the opinions of the American Society of Plastic Surgeons. Recent advances and future directions in postmastectomy breast reconstruction. You'll also have stitches (sutures) after your surgery. Townsend CM Jr, et al. The main difference in the free TRAM reconstruction is that the tissue, rather than remaining attached, is completely removed from the body. All surgeons including the plastic surgeons and surgical oncologists work very closely to plan your surgical treatment and reconstruction. The TRAM flap can be transferred as a free flap or a pedicled flap. You may also choose to perform breast self-exams on your natural breast and the skin and surrounding area of your reconstructed breast. All of our surgeons are board-certified in plastic surgery and have years of experience in breast reconstruction procedures. Keep your expectations realistic about your surgery. If these fail, then there can be "flap death," and the new breast will be lost. Tissue from your back or less commonly your buttocks may also be used. One-stage immediate breast reconstruction may be done at the same time as mastectomy. 2022 Flap reconstruction. Twenty patients had stage III disease and 1 patient had stage IV disease. Smokers should stop cigarette smoking and nicotine substitutes for at least 4 weeks before the scheduled operation. There are two distinct approaches to a TRAM flap procedure: a "pedicled" TRAM, where the muscle and tissue are left attached to their original blood supply in the abdomen and are maneuvered underneath the skin to their new location in the chest, and a free TRAM, where those tissues are completely detached and then reattached to the blood vessels in the armpit area using advanced microsurgical techniques. It is important to note, however, that an individual patient's coverage may only provide a portion of the total fee. Advantages of using TRAM flaps are: Consistency of the reconstructed breast. Tissue from the abdomen used in TRAM flap reconstruction can be taken in two different ways: using a tunneling, pedicle, TRAM flap or using a free, microsurgical, TRAM flap. Choose a board-certified plastic surgeon and be confident you are in the care of a highly trained surgeon you can trust. Drains placed in the breast and donor area of the abdomen stay in place for two to three weeks while the patient recovers at home, and are taken out during an office visit. The technique takes its name from the portion of the Transverse Rectus Abdominis Myocutaneous (or TRAM) muscle that is used to give the attached tissue and fat an adequate blood supply. Not every woman is a candidate for this type of breast reconstruction, and it is best to discuss the pros and cons of these procedures with your surgeon. How is this TRAM flap reconstruction done? page 2. page 3 The aim of this booklet is to answer some of the questions you may have about recovering from your breast reconstruction surgery. In a DIEP flap reconstruction, fat, skin, and blood vessels are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. After the general surgeon removes the breast tissue, a plastic surgeon places a breast implant. Abdominal rejuvenation. Stay Informed. TRAM Flap Breast Reconstruction. If you would like an interpreter to help you understand any information on this website, please call TIS National on 131 450 and ask them to call Cancer Australia on 02 9357 9400. 20th ed. Tissue from the abdominal wall (tummy) can also be used as a pedicle flap (transverse rectus abdominis muscle or TRAM flap). It just seems strange that the breast cancer with tram flap was on the right side, the lung issus also on the right side. Before surgery, follow your doctor's instructions on preparing for the procedure. In some cases, the skin and tissue need to be augmented with a breast implant to achieve the desired breast size. The 2 most common types of tissue flap procedures are the TRAM flap (or transverse rectus abdominis muscle flap), which uses tissue from the lower tummy area . In these cases, breast reconstruction usually requires either a flap technique or tissue expansion. Mayo Clinic does not endorse companies or products. Following its removal from the abdomen, the tissue is transferred to the mastectomy site. The good news, is that you can have breast reconstruction surgery. For a muscle-sparing free TRAM flap, your surgeon takes only a portion of your rectus abdominis muscle, which may help you retain abdominal strength after surgery. One of the benefits of a TRAM flap breast reconstruction is that the breast (s) can be reconstructed without needing implants. 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. In the transverse rectus abdominis musculocutaneous (TRAM) flap procedure, a portion of the abdominal wall is transposed to the chest as a pedicle or free flap. breast reconstruction surgery (DIEP or TRAM flap) Information for patients. Pedicled TRAM flap reconstruction moves skin, fat, and muscle from the abdomen to recreate the breasts. . Unlock access to Before & After Photos, Ask a Surgeon and Patient Community with a Connect account on the ASPS website. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Connect with us. The most common type of autogeneous tissue (from one's own body) reconstruction is the pedicled transverse rectus abdominus myocutaneous (TRAM) flap. TRAM flap surgery uses the flap (graft) from this skin, fat, and the TRAM muscles for breast reconstruction. The TRAM flap procedure is the right fit for some patients, but it is important that your choice takes into consideration your body type, health, lifestyle, and personal reconstruction goals. Updates, advice and lifestyle tips from the ASPS delivered directly to your email inbox. The views expressed in Ask a Surgeon and the Patient Community are those of the participants and do not necessarily reflect the opinions of the American Society of Plastic Surgeons. By submitting this form, you accept the Cancer Australia privacy policy. An advantage to this type of breast reconstruction is that you'll retain more strength in your abdomen. Your surgeon determines which method is best for you based on your body type and your medical and surgical history. Additionally, as with all forms of surgery, patients should have no medical conditions, other illnesses or habits (such as smoking) which might impede the healing process, and should also have a thorough understanding of what the procedure will entail as well as reasonable expectations about its outcome. This procedure involves the creation of a new breast mound using skin and tissue taken from the abdominal region and has proven to be very effective in many patients who have been affected by breast cancer. During a deep inferior epigastric perforator (DIEP) flap procedure, the surgeon removes a section of abdominal skin and fat, along with the associated blood vessels. It takes between 2 to 4 hours depending on the size of the breast and whether any procedure will be done on the normal breast to lift, reduce, or shape it in any way. Guest over a year ago. TRAM flap reconstruction, the most common of these methods, involves using tissue from the area below the belly button. A pedicled TRAM flap uses your whole rectus muscle one of the four major muscles in your abdomen. collected, please refer to our Privacy Policy. This video is available for instant download licensing here: https://www.alilamedicalmedia.com/-/galleries/narrated-videos-by-topics/breast-reconstructionVoi. Avoid exposing scars to sun for at least 12 months. This may include guidelines on eating and drinking, adjusting current medications, and quitting smoking. Although the pedicled TRAM flap donor area reinforced with mesh results in decreased rates of postoperative abdominal bulging and hernias, the best technique to accomplish that is yet to be elucidated. The procedure is done under general anesthesia. During the operation, your surgeon will assess the blood vessels in your lower abdomen. Learn more about DIEP breast reconstruction. When the skin-sparing mastectomy is finished, all of the breast skin (except the nipple and . Estimated recovery time: Hospitalization is usually 4 to 6 days. The muscle is left attached to the ribcage above and the muscle is divided below. . 2016;23:3100. TRAM Flap reconstruction has been around for a long time, and many surgeons know how to do it. The treatment that your doctors recommend will depend on the type of cancer you have, how advanced it is, and other personal factors. If you are ready for a consultation about breast reconstruction, call 734-998-6022 to schedule an appointment with one of our specialty plastic surgeons. The free TRAM flap is a breast reconstruction that uses the abdominal tissues from the belly button to the pubic area to reconstruct one or both breasts. The TRAM flap operation entails the transferring of fat, skin, and muscle from the lower abdominal wall to the chest to reconstruct the breast. The hospital stay is anywhere between 3 to 5 . Excess living fat from below the belly button is transplanted to the chest to give back volume and shape, offering a safe alternative to TRAM and Latissimus flap procedures. Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. Cancer Australia was established by the Australian Government in 2006 to benefit all Australians affected by cancer, and their families and carers. DIEP Flap Breast Reconstruction Post-Operative Instructions - 2 - How do I take care of my incision? TRAM flap surgeryis a surgical reconstruction technique of the breast in which tissue from the lower abdominal wall is grafted onto the chest. Breast reconstruction is surgery to create a new breast shape in place of a breast that has been removed (mastectomy). Your surgeon transfers a section of skin, muscle, fat and blood vessels from one part of your body to your chest to create a new breast mound. If you smoke, you may be asked to quit for four to six weeks before your surgery. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The recovery from a TRAM flap procedure is also far more intensive. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018. This procedure takes its name from the transverse rectus abdominis muscle in your tummy. Get started today! Your body type, health status and cancer treatment factor into which type of reconstruction will give you the best result. This muscle is elevated off the back with skin, fat, and attached blood vessels (thoracodorsal artery and vein) and transferred through the armpit into the breast pocket. TRAM flap (and other abdominal flap based breast reconstruction) can weaken the abdominal wall, causing abdominal bulges. The skin, fat, blood vessels and at least one abdominal muscle are moved from the stomach to the chest. The muscle carries the blood supply for the flap. DIEP flap breast reconstruction has been compared to a tummy tuck, as the abdomen also loses a large amount of fat and skin without touching the muscle. Finally, the cost of a TRAM flap breast reconstruction will often vary depending on the surgeon's experience and geographic location, but breast reconstruction surgery after breast cancer is considered a reconstructive procedure and should be covered by most health insurance plans. If you don't have excess abdominal tissue or you've had abdominal surgery in the past, you may not be a candidate for a TRAM flap reconstruction. A total of 26 TRAM flaps were performed; 5 patients had bilateral procedures. Summary background data: The transverse rectus abdominis muscle (TRAM) flap for breast reconstruction involves a a vascular pedicle and recipient bed, both included in the radiated field of patients undergoing adjunctive . Your plastic surgeon may discuss the pros and cons of surgery on your opposite breast, even if it's healthy, so that it more closely matches the shape and size of your reconstructed breast. Breast reconstruction may also entail reconstruction of your nipple, if you choose, including tattooing to define the dark area of skin surrounding your nipple (areola). The views expressed in Ask a Surgeon and the A single copy of these materials may be reprinted for noncommercial personal use only. Wearing an elastic bandage or support bra can help keep swelling down and support your breast while it heals. Mammography isn't necessary on breasts that have been reconstructed. An autologous flap procedure uses a combination of skin, fat, and/or muscle that is moved from areas such as your abdomen, upper back, upper hip, or buttocks to the chest where it is shaped into a new breast. Cancer Australia aims to reduce the impact of cancer, address disparities and improve outcomes for people affected by cancer by leading and coordinating national, evidence-based interventions across the continuum of care. If you've had only one breast reconstructed, you'll need to have screening mammography done regularly on your other breast. Information on more than 70 types of cancer. This method transfers the tissues of the lower abdomen along with the rectus muscle ("ab muscle") to the site where the new breast is to be constructed. Ideal candidates for a TRAM flap breast reconstruction are women who have undergone a single or double mastectomy for the treatment of breast cancer and who have enough fat and tissue in the abdominal area to support the procedure. Transverse Rectus Abdominis Myocutaneous ( TRAM) flap reconstruction was developed in the 1980s as one of the first alternatives to implant-based surgery. But this has been largely replaced by its . One common flap procedure is known as TRAM, or traverse rectus abdominal muscle, flap reconstruction. The different types of flaps from your abdomen that may be used to re-create a breast mound are listed below: Pedicled Transverse Rectus Abdominis Myocutaneous (TRAM): this flap is rotated on its blood supply and consists of skin, fatty tissue and muscle, with or without fascia. You can return to work after 4 to 6 weeks, depending on your job, and should avoid vigorous activities for 6 to . Originally developed in the 1980's by Dr. Carl R. Hartrampf, a TRAM flap procedure involves moving a small amount of the patient's abdominal tissue, including fat and muscle, to the chest, where it can then be used to rebuild the breast mound. National Cancer Institute. Advertising revenue supports our not-for-profit mission. It creates a natural-looking breast. Surgery requires about two to three hours to perform. A free TRAM has several important advantages over the pedicled TRAM flap. When the tissue is brought up to the mastectomy site, the flap is connected to the circulation of the breast. Make a donation. During a free TRAM flap procedure, the surgeon disconnects a section of abdominal tissue including skin, fat and sometimes muscle from its blood supply and attaches the tissue to blood vessels in your chest area using microsurgical techniques. Flap-based surgery. There are many different ways in which the surgery can be carried out, however, the TRAM flap procedure remains the option of choice for many surgeons. DIEP breast reconstruction (deep inferior epigastric perforator flap) is an advanced microsurgical technique that is used to rebuild the breasts after mastectomy. A TRAM flap uses donor muscle, fat and skin from a woman's lower abdomen to reconstruct the breast. Your surgeon removes tissue including muscle from your abdomen in a procedure known as a transverse rectus abdominis muscle (TRAM) flap. TRAM flap breast reconstruction is performed with general anesthesia. In: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Breast reconstruction with flap surgery involves taking a section of tissue from one area of your body most often your abdomen and relocating it to create a new breast mound. Autologous tissue breast reconstruction uses one of two surgical methods: In a pedicle TRAM flap procedure, the surgeon cuts a section of skin, muscle, fat and blood vessels from your abdomen, tunnels the tissue underneath your skin to its new location, and uses it to form a new breast mound. After your breast has healed from reconstruction or mastectomy, a plastic surgeon can reconstruct a new nipple and areola. Transaxillary incision: An incision made in the underarm area. Breast reconstruction offers many benefits, but it won't make your breast look or feel exactly like it did before your mastectomy. Hernia risk with DIEP flap. https://www.cancer.gov/types/breast/reconstruction-fact-sheet. The TRAM flap (Transverse Rectus Abdominus Myocutaneous) is a tissue flap procedure that uses muscle, fat, and skin from your abdomen to create a new breast mound after a mastectomy. After recovery from surgery most women report that they are pleased with the outcome and believe that they made the correct choice. It typically . The surgery's tongue-twister of a name comes from the branches of the primary blood vessel relocated during the procedure, the deep inferior epigastric perforator (DIEP). Your doctor will let you know of any restrictions to your activities, such as avoiding overhead lifting or strenuous physical activities. Breast Reconstruction Using TRAM Flap / Free TRAM Before & After Photos Performed by Franklyn Elliott, M.D. Conversely, a "muscle-sparing" free TRAM flap uses a smaller portion of the rectus muscle, so women tend to recover more quickly and have a lower risk of losing abdominal muscle strength. Ideally, your breast surgeon and the plastic surgeon should work together to develop the best surgical treatment and breast reconstruction strategy in your situation. This site complies with the HONcode standard for trustworthy health information: verify here. Pre-Op Post-Op Breast Reconstruction Using TRAM Flap / Free TRAM Case #6. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. While looking forward to finishing their cancer treatment and getting on with life, for some people, the end of treatment can also be a confusing or worrying time. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Of the 26 TRAM flaps, 17 were immediate and 9 were delayed . While each approach has distinct advantages that allow it to be customized to the needs of the individual patient, one of the most effective and versatile of the autologous tissue breast reconstruction methods is still the classic TRAM flap breast reconstruction technique. This study describes the experience of radical mastectomies with simultaneous breast reconstruction using TRAM flap in patients with inflammatory breast cancer. Accessed Nov. 13, 2018. The tissue for reconstructing your breast most often comes from your abdomen. Breast Reconstruction with TRAM Flap Photos Browse Breast Reconstruction with TRAM Flap before & after photos shared by doctors on RealSelf. Depending on the size and condition of the blood vessels, they will perform one of the following procedures. Enhancing your appearance with breast reconstruction . Breast reduction, Breast reconstruction with flap surgery, Breast lift, Breast augmentation, Rhinoplasty, Cosmetic surg. Some surgeons prefer the "free flap" method to the "tunneling" method because they may be better able to sculpt the tissue to the shape of a normal breast (and thus to match the other breast). The surgeon makes a star-shaped incision to form the new nipple and then adds a tattoo to shade in the new areola. Also, obesity may preclude you from having a pedicled TRAM flap. Abdomen (TRAM flap). The views expressed in Ask a Surgeon and the Patient Community are those of the participants and do not necessarily reflect the opinions of the American Society of Plastic Surgeons. Getting back to normal activities may take up to six weeks or more. Although the inspiring women who struggle against and overcome breast cancer are all on a similar journey, no two are ever on exactly the same path, which is one of the reasons why there are so many different approaches to breast reconstruction surgery. Also, there may be less satisfaction with cosmetic outcomes after surgery. Because adequate blood supply is critical to the survival of transplanted tissue in flap surgery, your surgeon may prefer not to perform a pedicled flap procedure if you're a smoker or if you have diabetes, vascular disease or a connective tissue disorder. However, the latter can be minimized through the use of advanced surgical techniques and both side effects will generally fade gradually over time. Candidates for TRAM flap breast reconstruction Abdomen (TRAM flap). Delayed breast reconstruction is considered more challenging than immediate reconstruction. surgeons or share your journey with other people just like you on the Patient Community. The thought of losing my breast made me contemplate suicide. Your doctor can prescribe medication to control your pain. Surgery to remove your healthy breast (contralateral prophylactic mastectomy) can double the risk of surgical complications, such as bleeding and infection. It is brought up and out through the mastectomy site (or scar depending on time of reconstruction). In the TRAM procedure, the skin, fat, and muscle of the lower abdomen are used to recreate the breast. or share your journey with other people just like you on the Patient Community. ery, Reconstructive surgery, Breast reconstruction, Liposuction, Flap surgery, Breast reconstruction with breast implants, Breast surgery. The Pedicled TRAM Flap is a traditional approach that transfers tissue from that area with the rectus muscle to the chest to create a breast. Breast reconstruction- Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Staged reconstruction of right breast delayed after mastectomy with TRAM Flap. The surgery may be done to reconstruct either one breast (unilateral) or both breasts (bilateral). A mouthful, but a lifesaver. Figs. Woman after mastectomy: showing TRAM and surrounding tissues in preparation for breast reconstruction. 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