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Tram Procedure

The Tram procedure, which refers to the Transverse Rectus Abdominis Myocutaneous Flap, is also known as Autologous Breast Reconstruction.

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Autologous breast reconstruction refers to the creation of a new breast mound from the patient’s own tissue. This involves using the patient’s own muscle, skin and fat from another part of the body. In the TRAM, the donor site is from the lower abdomen and the tissue between the umbilicus and the pubis is used. The most common technique for this procedure is the pedicle method. This means, the muscle and tissue are harvested and tunnelled upwards from the donor site to the breast region while still attached to its own blood supply. Typically, there is enough tissue to reconstruct large breasts. The abdominal incision extends from hip to hip and the contour of the lower abdomen is improved, offering the affects of a “tummy tuck”. It is important to note however, this may weaken the abdominal muscles, therefore, a piece of surgical mesh is placed over the defect and sutured in place to prevent greater muscle weakness and hernias.

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The goal of breast reconstruction is to match the affected breast as closely as possible in shape and size to the natural breast. In the case of bilateral reconstruction (both breasts), this procedure allows for greater flexibility in size, selection and symmetry. Dr. Van Laeken will help you determine if this is an appropriate procedure for you. She will review the surgical techniques and share with you, before and after photos at the time of your consultation.

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This procedure can be done either at the time of the mastectomy (immediate reconstruction) or later (delayed reconstruction).

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Breast reconstruction makes many women feel better about their appearance however, it is important to be realistic about the expected outcomes. A reconstructed breast won’t look exactly like your original breast nor will the sensation be similar. In general, flap procedures behave like the rest of your body. Consequently, the graft may enlarge or shrink as you gain or lose large amounts of weight.

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The completed reconstruction can take 9-12 months and requires 2 operative procedures.

Who is a candidate?

  • Patients who have had a mastectomy

  • Patients with an adequate amount of abdominal tissue

  • More likely offered to women requiring radiation as a reconstructive option

  • Non-smokers

  • Women who have any of the following conditions may not be candidates for tissue flap reconstruction:

    • Diabetes

    • Vascular Disease

    • Connective Tissue Disorders

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Preparation for surgery

Prior to your TRAM surgery, you will undergo a thorough pre-operative evaluation, including a physical exam, blood work, and potentially imaging studies to assess your abdominal wall strength.

 

If you are a smoker you must quit smoking before your surgery for at least 14 days. Smoking can interfere with the blood flow to the skin, and will inhibit the healing of the incisions. It is crucial to maintain a healthy diet and weight in the weeks leading up to surgery. You will also receive detailed instructions regarding medications to be avoided and the importance of wearing compression garments after surgery to minimize swelling and support the flap.

Procedure

Dr. Van Laeken operates at several different hospitals, but generally performs breast reconstruction surgeries at Mt. St. Joseph's or St. Paul's Hospital.  

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The TRAM procedure is a lengthy operation, typically lasting several hours. You will be placed under general anesthesia. An incision is made in the lower abdomen, carefully dissecting the transverse abdominis muscle and surrounding tissue to create a flap. This flap is then transferred to the chest and secured to the remaining breast tissue, effectively reconstructing the breast. The abdominal incision is subsequently closed in multiple layers. Careful attention is paid to preserving the blood supply to the flap, as this is crucial for its long-term survival and the appearance of the reconstructed breast.

Recovery

Recovery from a TRAM procedure is a significant undertaking. Initially, you will experience considerable pain and discomfort, requiring strong pain medication. Gradual increases in activity are allowed as tolerated, but heavy lifting and strenuous activity are strictly prohibited for several weeks. You will need to wear a compression garment for an extended period to support the flap and minimize swelling. Full recovery can be expected to take several months.

Potential Complications

There are risks associated with any type of surgery. Although the incidence of complications is rare, Dr. Van Laeken feels that all patients should be informed of the potential complications prior to proceeding with surgery.  The TRAM procedure carries a higher risk of complications compared to simpler flap techniques. These may include;​​

Abdominal Hernia

Protrusion of abdominal contents through a weakened area in the abdominal wall, often occurring at the site of a surgical incision or natural weak point.

Anesthetic Issues

Adverse reactions to local or regional anesthesia, ranging from mild discomfort and itching to more severe complications such as allergic reactions, nerve damage, or hypotension.

Asymmetry

Symmetry is not always achieved.

Circulation Problems

Impaired blood flow, resulting in reduced oxygen and nutrient delivery to tissues.

DVT / PE

Abbreviations of Deep Vein Thrombosis and Pulmonary Embolism. DVT is a blood clot in a deep vein, typically in the leg. PE is a potentially life-threatening condition where a DVT breaks loose and travels to the lungs, obstructing blood flow.

Infection

Signs of infection are localized heat, redness, fever, and pain. Dr. Van Laeken can prescribe antibiotics to treat the infection. Occasionally the area will need to be drained.

Keloid Scarring

Keloid scars are thick, wide, or raised scars.

Muscle / Abdominal Weakness

Compromised muscle strength and function, resulting in reduced ability to perform voluntary movements.

Necrosis

Tissue loss that can occur when blood supply to the skin and tissue is compromised.

Seroma

Serum can accumulate underneath the skin. On occasion it is necessary to have the fluid drained.

Contact us

To find out more or to book your consultation.

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