Breast Reconstruction Pathways
Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Breast Reconstruction
A Transverse Rectus Abdominis Myocutaneous (TRAM) flap is a breast reconstruction procedure that uses skin, fat, blood vessels, and part of the abdominal muscle from the lower belly to create a new breast mound, often with a “tummy tuck” effect but higher risk of abdominal weakness.
The TRAM flap (Transverse Rectus Abdominis Myocutaneous flap) is one of the original forms of natural tissue breast reconstruction. It uses skin, fat, and sometimes muscle from the lower abdomen to rebuild the breast.
Like the DIEP flap, the TRAM flap also provides a “tummy tuck” effect by removing tissue from the belly. But unlike the DIEP, this procedure may involve using part of the abdominal muscle to help bring blood supply to the flap.
How It Works
A section of skin, fat, blood vessels, and sometimes muscle is taken from the lower abdomen.
The tissue is shaped into a new breast mound.
The abdominal wall may be left weaker, since muscle is either rotated or fully removed to carry blood supply.
The surgery can be done as:
Pedicled TRAM flap: Tissue (including part of the rectus muscle) is tunneled under the skin to the chest while keeping its original blood supply.
Free TRAM flap: Tissue is completely detached and reconnected to chest blood vessels using microsurgery.
Who May Be a Candidate
TRAM flap reconstruction may be an option if:
You want a natural tissue breast reconstruction using your own body.
You have enough abdominal tissue to donate.
You are not a candidate for DIEP flap reconstruction (due to vessel anatomy, medical history, or surgeon preference).
You are healthy enough for a longer surgery and recovery.
Benefits of TRAM Flap Reconstruction
Natural look and feel: Breasts reconstructed with your own tissue tend to look and feel more natural than implants.
Long-lasting results: Flap tissue usually lasts a lifetime, unlike implants which may need replacement.
Body contouring: Creates a flatter, tighter lower abdomen, similar to a tummy tuck.
Reliable technique: TRAM flaps have been performed successfully for decades.
Things to Keep in Mind
Muscle sacrifice: Part of the abdominal muscle is often used, which may increase the risk of weakness, hernia, or bulging compared to DIEP or SIEA flaps.
Longer recovery: Healing usually takes 4–6 weeks, with abdominal soreness common.
Scarring: Leaves a horizontal scar across the lower abdomen and one at the breast site.
Not for everyone: Women who are very thin, smoke, or have certain health issues may not be candidates.
Complex surgery: Requires significant surgical expertise, particularly with free TRAM flaps.
Emotional Considerations
Some women appreciate the natural results and the reliability of TRAM flaps, especially if implants aren’t an option. Others may feel concerned about losing muscle strength or facing a longer recovery. Both feelings are normal, and discussing your lifestyle and goals with your surgeon can help clarify if TRAM is the right fit.
A Personal Choice
The TRAM flap rebuilds the breast with your own abdominal tissue—offering natural, lasting results, but with some trade-offs in recovery and muscle strength. It is one of the most time-tested natural tissue reconstruction techniques, offering beautiful, lasting results for many women. While it does involve using abdominal muscle, it remains an important option—especially when DIEP or SIEA flaps aren’t possible.