Prolonged time in surgery and under anesthesia, Tissue death (necrosis) due to insufficient blood supply, Loss of sensation at the tissue donor site, Help your breasts look natural under clothing or a bathing suit, Help you avoid the need for using a form (external prosthesis) inside your bra, Partially erase the physical reminders of your disease, Require additional surgery to correct reconstructive problems, Give your reconstructed breast the same sensations as your normal breast. After chemotherapy finished, I began to investigate.being an RN, it's in my nature to look at online journals. Read more. You may be interested in the final touches of either nipple reconstruction or 3D nipple tattooing. If you don't have excess abdominal tissue or you've had abdominal surgery in the past, you may not be a candidate for a TRAM flap reconstruction. Your body type, health status and cancer treatment factor into which type of reconstruction will give you the best result. Flap procedures, also called autologous tissue reconstruction, which use tissue from another part of a woman's body to form a new breast Women who underwent flap procedures reported significantly greater satisfaction with their breasts, sexual well-being, and psychosocial well-being than women who underwent implant reconstruction. Your surgeon removes tissue including muscle from your abdomen in a procedure known as a transverse rectus abdominis muscle (TRAM) flap. collected, please refer to our Privacy Policy. In the transverse rectus abdominis musculocutaneous (TRAM) flap procedure, a portion of the abdominal wall is transposed to the chest as a pedicle or free flap. or post your question to Ask a Surgeon to get an authoritative and trustworthy answer from our ASPS member surgeons. Breast reconstruction using your own tissue without the use of implants is called autologous (referring to your own tissue) flap surgery. . The surgeon makes a star-shaped incision to form the new nipple and then adds a tattoo to shade in the new areola. If you would like an interpreter to help you understand any information on this website, please call TIS National on 131 450 and ask them to call Cancer Australia on 02 9357 9400. If performed immediately after mastectomy, the entire operation requires about four to five hours. To complete this operation, surgeons use tissue from your lower abdomen to create a new breast. The TRAM flap (Transverse Rectus Abdominus Myocutaneous) is a tissue flap procedure that uses muscle, fat, and skin from your abdomen to create a new breast mound after a mastectomy. Transverse rectus abdominus myocutaneous (TRAM) flap breast reconstruction involves rebuilding a breast shape by moving skin, fatty tissue and part of the rectus abdominus muscle from the abdomen (stomach) to the chest. Overall, TRAM flaps are the most commonly performed type of flap reconstruction, partly because TRAM flap tissue is very similar to breast tissue and makes a good substitute. The study aimed to evaluate the effectiveness of primary breast reconstruction using the TRAM-flap procedure in patients with an inflammatory form of breast cancer. An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks. . TRAM Flap Breast Reconstruction. A flap of this skin, fat, and all or part of the underlying rectus abdominus ("6-pack") muscle are used to reconstruct the breast in a TRAM flap procedure. One of the benefits of a TRAM flap breast reconstruction is that the breast (s) can be reconstructed without needing implants. Free TRAM flap Your surgeon will cut a flap that includes your abdominal muscle on one side . Your doctor can prescribe medication to control your pain. Flap reconstruction. Consult a plastic surgeon who's board certified and experienced in breast reconstruction following mastectomy. Not every woman is a candidate for this type of breast reconstruction, and it is best to discuss the pros and cons of these procedures with your surgeon. Accessed Sept. 20, 2018. Nahabedian M. Options for flap-based breast reconstruction. The creation of a new breast can dramatically improve your self-image, self-confidence and quality of life. The tissue for reconstructing your breast most often comes from your abdomen. Single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap (19367) Single-pedicled TRAM flap "supercharged" by microvascular anastomosis (19368) Bi-pedicled TRAM flap (19369). Breast reconstruction is a surgical procedure that restores shape to your breast after a mastectomy surgery that removes your breast to treat or prevent breast cancer. A pedicled TRAM flap uses your whole rectus muscle one of the four major muscles in your abdomen. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition. This is not a microsurgical procedure. 2018;98:845. Share your journey with other people just like you on the Patient Community or post your question to Ask a Surgeon to get an authoritative and trustworthy answer from our ASPS member surgeons. Image Credit Woman after mastectomy: showing TRAM and surrounding tissues in preparation for breast reconstruction. After your breast has healed from reconstruction or mastectomy, a plastic surgeon can reconstruct a new nipple and areola. This method transfers the tissues of the lower abdomen along with the rectus muscle ("ab muscle") to the site where the new breast is to be constructed. Estimated recovery time: Hospitalization is usually 4 to 6 days. Flap-based surgery. It creates a natural-looking breast. The plastic surgeon also provides information on anesthesia, where the operation will be performed and what kind of follow-up procedures may be necessary. If your surgeon can't perform a DIEP flap procedure for anatomical reasons, he or she might opt for the msTRAM procedure instead. (below) Rectus Abdominis muscle rotated up to chest It takes between 2 to 4 hours depending on the size of the breast and whether any procedure will be done on the normal breast to lift, reduce, or shape it in any way. The procedure is usually done by plastic surgeons but the patient monitoring in the immediate post-operative period is done by specialty-trained wound and plastic nurses. The muscle carries the blood supply for the flap. Advantages of using TRAM flaps are: Consistency of the reconstructed breast. Anesthesia: A pedicled TRAM flap is performed with the patient under general anesthesia. This requires that the artery and vein which supply blood to the flap tissue to be moved as well. You may shower 72 hours after surgery with drains in place. Pedicled TRAM flap reconstruction moves skin, fat, and muscle from the abdomen to recreate the breasts. You should consider a TRAM flap breast reconstruction if you: If you have further questions or would like to schedule a breast reconstruction consult, please contact us. In this flap procedure, the surgeon takes tissue from the latissimus dorsi muscle in your back, tunnels it underneath your skin to its new location and uses it to form a new breast mound. https://www.cancer.gov/types/breast/reconstruction-fact-sheet. Flap procedures result in larger incisions that take longer to heal, so they require a longer recovery period and may require a longer hospital stay. Because TRAMP flap takes a section of the muscle wall, you will not be able to lift heavy weights during recovery. Flap reconstruction requires specialized training in reconstructive microsurgery, which not all breast surgeons have. Smokers should stop cigarette smoking and nicotine substitutes for at least 4 weeks before the scheduled operation. Objective: Patients with and without radiation treatment before their breast reconstruction were compared to study the relationship of radiation to flap-related complications. In case of a double mastectomy, the tissue on the lower abdomen may be used to make two breasts. Mayo Clinic is a not-for-profit organization. Breast reconstruction- Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Staged reconstruction of right breast delayed after mastectomy with TRAM Flap. ery, Reconstructive surgery, Breast reconstruction, Liposuction, Flap surgery, Breast reconstruction with breast implants, Breast surgery. TRAM flap breast reconstruction is performed with general anesthesia. DIEP breast reconstruction (deep inferior epigastric perforator flap) is an advanced microsurgical technique that is used to rebuild the breasts after mastectomy. This video is available for instant download licensing here: https://www.alilamedicalmedia.com/-/galleries/narrated-videos-by-topics/breast-reconstructionVoi. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. The technique takes its name from the portion of the Transverse Rectus Abdominis Myocutaneous (or TRAM) muscle that is used to give the attached tissue and fat an adequate blood supply. However, the contour of your new breast can usually be restored so that your silhouette looks similar to your silhouette before surgery. Because adequate blood supply is critical to the survival of transplanted tissue in flap surgery, your surgeon may prefer not to perform a pedicled flap procedure if you're a smoker or if you have diabetes, vascular disease or a connective tissue disorder. 2022 I am new to writting about this, altho have needed someones input or help. The recuperation after a TRAM flap is longer than after staged implant procedures. After the general surgeon removes the breast tissue, a plastic surgeon places a breast implant. This is the most common method of breast reconstruction using the patients own tissue. In a properly performed DIEP, no abdominal muscle is cut or removed. During the visit, you will have a chance to ask questions, choose a surgical plan, and discuss preparation and recovery. In general, this means cutting away at least some of your stomach muscles, fat and blood. Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. Pre-Op Post-Op Breast Reconstruction Using TRAM Flap / Free TRAM Case #6. . Your plastic surgeon will describe your surgical options and may show you photos of women who have had different types of breast reconstruction. Breast reconstruction is the surgical process of rebuilding the shape and look of a breast, most commonly in women who have had surgery to treat breast cancer. TRAM flap reconstruction, the most common of these methods, involves using tissue from the area below the belly button. Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. Recent advances and future directions in postmastectomy breast reconstruction. They'll probably be absorbable sutures, though, so you won't need to have them removed. Length of procedure: 3 to 4 hours for one breast, 5 to 6 hours for two breasts. What we offer Services Breast Reconstruction more info Reconstruction After Prophylactic Mastectomy more info Breast Reduction more info Mean patient age was 49 years. Accessed Nov. 13, 2018. Your plastic surgeon may recommend a two-stage procedure. Find out about COVID-19, COVID-19 vaccines, and Mayo Clinic patient and visitor updates. It involves using autologous tissue, prosthetic implants, or a combination of both with the goal of reconstructing a natural-looking breast. More plastic surgeons have experience doing implant-based breast reconstruction. Much of the breast reconstruction using your body's own tissue can be accomplished at the time of your mastectomy (immediate reconstruction), though sometimes it can be done as a separate procedure later (delayed reconstruction). Blood vessels are not severed, so blood is supplied to the transferred fat and skin through a small portion of the rectus abdominus muscle. This procedure uses either your natural tissue, breast implants, or a combination of the two to help rebuild and restore one or both breasts after cancer treatment. If you have implants, no showering until drains are removed. Since the patients own body tissue is used, the result is a very natural breast reconstruction. Post your question to Ask a Surgeon to get an authoritative and trustworthy answer from our ASPS member The initial TRAM flap operation is 3-5 hours with 4-6 weeks recovery You may require 1 or more revision surgeries to shape and tweak your new breast. Some women also consider it a bonus that the tummy is left relatively flat after removing the tissue flap (a tummy tuck effect). The surgeon will be able to identify donor sites that will work for your body. COVID-19 information for people affected by cancer, Managing your cancer care in the context of COVID-19, COVID-19 information for children and young people with cancer, Cancer and COVID-19 - what it means for our Mob, COVID-19 vaccines: Information for Aboriginal and Torres Strait Islander people affected by cancer, Cancer care for cancer patients with COVID-19, Cancer care in the time of COVID-19: A conceptual framework, Optimal cancer care during the COVID-19 pandemic: the Principles, The impact of COVID-19 on cancer services, COVID-19 Recovery: Implications for cancer care, Changes to prevention and early detection, Innovative care and hospital infrastructure models, Collaboration in the oncology sector and data sharing, Working with Aboriginal and Torres Strait Islander people, For Aboriginal and Torres Strait Islander people, Comparing different types of breast reconstruction, Possible complications of a tissue flap breast reconstruction, What to expect with a TRAM flap breast reconstruction, Other tissue flap breast reconstruction procedures, Breast reconstruction after preventive mastectomy, Post-operative recovery after a TRAM flap breast reconstruction, Questions to ask your breast reconstruction surgeon. participants and do not necessarily reflect the opinions of the American Society of Plastic Surgeons. Additionally, as with all forms of surgery, patients should have no medical conditions, other illnesses or habits (such as smoking) which might impede the healing process, and should also have a thorough understanding of what the procedure will entail as well as reasonable expectations about its outcome. Your health and safety remain our top priority: Learn about our Safe Care Commitment | Use our Prescreen app before arrival for faster entry | Read the COVID-19 Vaccine FAQs. Most of the abdominal muscle is left in place and minimal muscle tissue is taken to form the new breast mound. Dhruv Gupta, MD answered this TRAM Flap Procedure For Breast Reconstruction . During the operation, your surgeon will assess the blood vessels in your lower abdomen. There are many different ways in which the surgery can be carried out, however, the TRAM flap procedure remains the option of choice for many surgeons. Avoid exposing scars to sun for at least 12 months. Skin, muscle and fat tissues are transferred from the donor site on the abdomen to the chest wall. A woman showing the lines of TRAM reconstruction incisions. You may be tired and sore for a few weeks after your surgery. Breast Reconstruction with TRAM Flap Photos Browse Breast Reconstruction with TRAM Flap before & after photos shared by doctors on RealSelf. Conversely, a "muscle-sparing" free TRAM flap uses a smaller portion of the rectus muscle, so women tend to recover more quickly and have a lower risk of losing abdominal muscle strength.
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