TRAM flap breast reconstruction using the ‘pedicled’ method involves moving skin, fatty tissue and muscle from the abdomen to the chest through a ‘tunnel’ made under the skin of the abdomen. The blood vessels supplying the tissue flap remain intact. This operation usually takes around 4-6 hours.
TRAM flap breast reconstruction using the ‘free’ tissue flap method, involves cutting the blood vessels that supply the tissue flap. The blood vessels are then rejoined to blood vessels in the chest area. This surgery is more complex than the pedicled method and can take 5–7 hours.
The free tissue flap method is often better for rebuilding larger breasts. More tissue can be moved to the breast area and the breast reconstruction surgeon can shape the reconstructed breast(s) more easily. A free tissue TRAM flap also uses less abdominal muscle and has better blood flow than a pedicled TRAM flap.
Some women need to have a CT angiography before they can have TRAM flap breast reconstruction surgery. This is a scan to check whether the blood vessels in the abdomen are suitable for a TRAM flap. A dye is injected into a vein in the arm. The dye moves around the body and a scan is taken when the dye reaches the blood vessels in the abdomen.