Evolution of TRAM Flap Breast Reconstruction - General Overview

Evolution of TRAM Flap Breast Reconstruction - General Overview

Breast reconstruction can be performed using implants or the patient’s own tissues.

Using the patient’s own tissues is referred to as an autologous reconstruction.

The TRAM flap is one of many different options available to patients desiring an autologous breast reconstruction.

Over the past 30 years there has been continual refinement in TRAM flap breast reconstruction technique. Ongoing modification has been fuelled by improved technology, expanding surgical knowledge and the constant striving for better results, both in terms of improved breast aesthetics and less damage to the tummy.

The first described procedure left the upper end of the rectus abdominis muscle attached to the body at the rib cage (pedicled TRAM flap) and tunnelled the tissue under the skin to reach the chest removing the entire recutus abdominis muscle.

With the advent of microsurgery and increasing knowledge of tissue microcirculation, the technique evolved into complete detachment of the TRAM flap from the body (free TRAM flap) with re-attachment to blood vessels on the chest. This involved working with an operating microscope and suturing together blood vessels of up to 2mm in diameter using suture material finer than a human hair. Now only half of the rectus abdominis muscle was being removed.

With the aim of preserving as much rectus abdominis muscle as possible on the tummy, the free TRAM flap was further modified to a muscle-sparing TRAM flap (msTRAM) so only 10-20% of the muscle was being removed.

The most recent advance in the evolution of TRAM flap breast reconstruction has been the DIEP (Deep Inferior Epigastric Perforator) flap, which preserves even more of the rectus abdominis muscle. Pre-operative investigation of the tummy blood vessels is often undertaken with a CT angiogram to assist with surgical planning.

The DIEP flap has become the gold standard for autologous breast reconstruction in the UK and Europe, and will fast achieve the same level of popularity in Australia.