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Breast reconstruction following the removal of the breasts, most commonly due to breast cancer, is a complex plastic surgery procedure. 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.

TRAM stands for Transverse Rectus Abdominus muscle, also called as the six-pack muscle. The procedure basically involves the removal of this muscle along with a layer of fat, accompanying blood vessels and then transporting them to the site of reconstruction.

The reason for this procedure’s popularity is because the TRAM is very similar to the breast tissue and thus makes for an excellent substitute. It can be carried out in two ways:

  • Free TRAM flap

  • Pedicle TRAM flap

The difference between the two flaps is that the tissues to be transported remain attached to the base site in case of a Pedicle TRAM flap, while they are completely removed and then replaced in the case of a free TRAM flap.

Like all surgeries, the TRAM flap procedure also carries it with some risks that the patients should be aware of.

Risks With TRAM Flap

Donor Tissue Breakdown

This is a condition in which the transported tissue does not get an adequate amount of blood flow and then begins to necrotize and get destroyed. If the amount of tissue getting affected is small, then the surgeon can re-enter the site and remove the affected tissue, however, in some cases the entire flap has to be removed and replaced.  

Lumps In The Breast

The reconstructed breast may have some firm lumps in it due to the fat being replaced by scar tissue formation. While these lumps are harmless in most cases, finding them in the reconstructed breast can be scary for the patient. Most surgeons opt to remove these pockets of scar tissue.

Muscular Weakness

Since this procedure involves the removal of a muscle, it ends up weakening the abdomen and increasing the risk of the patient developing a hernia. This is when an internal organ bulges through a weak spot a muscle and can cause pain and discomfort to the patient.

It can also result in the development of an unsightly bulge at the site of the hernia.

Studies have found that patients who have undergone a TRAM flap procedure are also much more likely to develop chronic back pain in the long run due the fact their abdominal muscles are weakened. These muscles are important supporting muscles of the body and a weakness in them can be quite problematic.


While a TRAM flap procedure remains a very popular choice all over the world, good patient selection is very critical to its success. Patients who have a low amount of belly fat, weak abdominal muscles, or those who are planning on getting pregnant in the future should not undergo this procedure.

Patients who have had multiple surgeries in the region of the abdomen should also not be considered for this procedure. Once the surgery has been performed, though, the patient should expect a long time of recovery and be informed of the usefulness of performing abdominal exercises to prevent long-term back pain.

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