What is a Free TRAM flap?

With this technique, skin and fat from the lower abdomen is removed, together with the vessels and muscles, reattached to the chest and then shaped to reform the breast. Small blood vessels from the tissue are connected to blood vessels in the chest, just under the rib, using microsurgery techniques.

In a free TRAM flap the tummy muscle is removed together with the overlying skin and fat, whereby in a DIEP flap no muscle is removed. The DIEP flap gives patients a shorter and easier recovery than the free TRAM flap, enabling them to maintain muscle strength.

What are the disadvantages of a free TRAM flap?

There is a risk of bulging and even hernia formation of the tummy due to the weakness occured by having the muscle removed.

Free TRAM Flap – overview

Operation time: Normally between 4-6 hours
Hospital Stay: Between 5-7 nights follwing the operation
Type of Anaesthesia: General anaesthetic
Recovery Time: 6-8 weeks
Risks of Surgery include:

Bruising, swelling and discomfort.

In rare cases, patients experience bleeding (haematoma), infection, failure of the flap (approx 2%), partial failure of flap, the need to re-operate (approx 8%), wound breakdown or necrosis of the mastectomy skin flaps.

Problems occurring a week after the operation can include temporary reduced sensation of the abdominal wall and reduced sensation of reconstructed breast.

Other (rare) problems can include scars – abdominal, umbilicus, breast unsightly, lumpy, stretch; bulging, weakness or hernia (4%) of the abdomen; seroma; and fat necrosis.

Further Treatment:

Visit to the hospital dressing clinic (a week after discharge)

Check up with your surgeon or registrar

Nipple reconstruction: Around 3 months later
Nipple Tattooing: 1 month after reconstruction (by your surgical team)