Revision & Refinement Surgeries

A Transverse Rectus Abdominis Myocutaneous (TRAM) flap is a type of natural tissue breast reconstruction that uses skin, fat, and sometimes muscle from the lower abdomen to rebuild the breast. Because this surgery removes or weakens part of the abdominal wall muscle, some women may later develop a hernia or bulge at the donor site.

A TRAM flap hernia (or bulge) repair is a procedure that strengthens and repairs the abdominal wall after this kind of reconstruction, helping restore comfort, core stability, and appearance.

Why a Hernia Can Happen After TRAM Flap

• In a TRAM flap, part of the abdominal muscle is moved or tunneled to the chest.

• This can leave a weakened area in the abdominal wall.

• Over time, a hernia (where tissue pushes through the weak spot) or a bulge (weakened but not fully herniated area) may appear.

• Risk is higher in women with a pedicled TRAM flap (where the muscle remains attached and is rotated) than in muscle-sparing flaps.

Not everyone develops a hernia, but if it does occur, it can cause discomfort, changes in appearance, or problems with activity.

How TRAM Flap Hernia Repair Works

Repairing the abdominal wall usually involves:

• Reducing the hernia: Any tissue or fat that has pushed through the weak spot is gently moved back into place.

• Reinforcing the abdominal wall: Surgeons often use a mesh (synthetic or biologic) to strengthen the repair and lower the risk of recurrence.

• Reshaping the area: Extra tissue may be adjusted to smooth out bulges and improve the abdominal contour.

• Same-day or short hospital stay: Most repairs are outpatient or require only a brief stay, depending on complexity.

Signs That Repair May Be Needed

You may benefit from a TRAM flap hernia repair if you experience:

• A visible bulge or lump in your lower abdomen.

• Discomfort or pain when standing, lifting, or exercising.

• A feeling of weakness in your core or trouble with posture.

• Changes in clothing fit due to the bulge.

Benefits of Hernia Repair

• Restores comfort: Reduces pain and pressure in the abdomen.

• Improves strength: Reinforces the abdominal wall for better stability.

• Smooths appearance: Reduces bulging, helping the abdomen look more natural.

• Protects health: Prevents the hernia from worsening or causing complications.

Things to Keep in Mind

• Healing time: Recovery is usually shorter than the original TRAM surgery, but rest and activity restrictions are needed.

• Scar tissue: Prior surgery can make the repair more complex, but experienced surgeons are skilled in these techniques.

• Mesh use: Mesh is often safe and effective but may not be suitable in every case.

• Recurrence risk: While repair strengthens the area, a small risk of hernia returning remains.

Emotional Considerations

Experiencing a complication like a hernia can feel frustrating after already going through breast cancer treatment and reconstruction. Many women feel discouraged by another surgery. It’s important to remember that hernia repair is common after TRAM flaps—and that repair often restores both comfort and confidence.

A Personal Choice

TRAM flap hernia (or bulge) repair is about restoring strength and comfort after breast reconstruction. Whether you notice a bulge, pain, or just want your abdomen to feel more stable, repair can help you move forward with greater ease. It helps you restore your core—so you can feel stronger, more comfortable, and more confident in your body again.