TRAM - Transverse Rectus Abdominus Muscle Flap

Like the DIEP and SIEA flaps, this procedure uses extra tissue from the lower abdomen and to recreate a breast and will result in a tightening of the lower abdomen or a "tummy tuck." The tissue from this area alone is often enough to create a breast and an implant is rarely needed. This tissue is usually transferred as a microvascular free flap. In this technique, the abdominal tissue is removed from its blood supply on the abdomen and reattached to blood vessels in the chest. Free flaps are more technically complicated than pedicled flaps (i.e. latissimus, T-DAP), and require the skills of plastic surgeons like the doctors at University Plastic Surgery who are experienced in microvascular surgery.

In certain cases, when for example, the blood vessels in the chest or abdomen aren't adequate, the skin, fatty tissue, blood vessels, and at least one of the abdominal muscles are tunneled under the skin from the abdomen to the chest area. This allows a new breast to be created without the need to disconnect the blood supply of the abdominal tissue.