The TRAM, or transverse rectus abdominis musculocutaneous, flap reconstruction procedure, uses the tissues of the abdomen (below the level of the belly button) to reconstruct the breast mound. Tissue from part of the stomach muscle is transferred as well. 

The donor site or abdomen usually requires mesh to repair where the muscle was taken from. The skin leaves an incision scar from hip to hip and around the belly button. Sacrifice of the muscle is not acceptable to many women when choosing reconstruction. Particularly when both breasts need reconstruction, this reconstruction has been associated with abdominal weakness (such as inability to sit-up normally), abdominal bulging, or even abdominal hernia.

drawing of TRAM procedure

free tram flap

The term “free” indicates that the TRAM is being transferred using microsurgical techniques. This means that the muscle is cut free with its associated blood vessels. The blood vessels are then reattached to donor vessels in the chest to re-establish flow in and out of the tissues. The tissue is then used to recreate the breast mound. While the added tissue dissection needed for tunneling of the flap is eliminated, the same donor site complications as the traditional TRAM flap remain. 

drawing of free TRAM procedure