Surgical Procedure
One or both of the Abdominus Rectus muscles will be used in the Tram Procedure. These essentially are the muscles that help you do a sit up. The muscle, skin and fat are harvested from the lower abdomen between the pubis and the umbilicus along with its blood supply and are tunneled up into position on the chest to create a breast mound.
The advantage of this procedure is that the patient will have fewer trips to the operating room for their overall reconstruction and the breast will feel more natural. Many individuals prefer the idea of using their own tissue to implants. This may minimize the concerns surrounding potential implant ruptures, future replacements and mammograms. The disadvantage of the Tram flap procedure is related to the loss of muscle from the abdomen that can contribute a hernia and create overall abdominal weakness. Also, fat necrosis is a possibility when the blood supply is impaired. This results in a hard and painful breast. In leaner individuals, a noticeable bulge can be identified just under the ribs where the muscle is folded upon itself. It is also likely you will feel the firm perimeter of the graft under the skin in the breast.
Occasionally, a balancing procedure is recommended for the unaffected breast to create greater symmetry. Typically, this involves a breast lift or reduction.
The nipple reconstruction will follow several months after the patient has healed from this exchange procedure. Finally, a tattoo of the aerola is performed to complete the process.
Potential Complications
- infection
- delayed wound healing
- circulation problems
- bleeding
- abdominal hernia
- fat necrosis
- seroma
- excessive scarring
- muscle (abdominal) weakness)
- DVT/PE
- breast asymmetry
- anaesthetic issues