Breast Surgery – Breast Reconstructions –
TRAM - ABDOMINAL TRANSVERSE MIOCUTANEOUS FLAP

This is one of the most recent techniques developed and is the one most used.

It is applicable to all patients, especially those that have abundant abdominal tissue below the navel.

Roughly, this technique consists of a abdominoplasty where an “ellipse” (spindle) of tissue below the navel is removed, and instead of disposing this tissue (as in abdominoplasty), we keep it attached to the rectus abdominalis muscle, and through a tunnel built under the overlying abdominal tissue we direct it to the area to be repaired of the breast removed.

It is an extremely interesting technique due to the abundance of tissue available to the plastic surgeon for modeling a new breast.

The results are gratifying since, when performed in patients already operated (late reconstruction) and who are suffering immensely by the amputation, it provides an extraordinary physical as much as psychic improvement.

It is an immediate reconstruction (concomitant with removal of the disease by the mastologist) and spares the patient the dramatic trauma of leaving the operatin room without the breast. Instead, the patient leaves without the disease and with the breast already reconstructed.

The volume and the breast cone are reconstructed on a first surgical session, and in the second session, i.e., an additional operation, the areola and nipple are reconstructed and the remaining contralateral breast is balanced to make it as similar as possible to the reconstructed side.

We reconstruct the areola with a skin graft removed from the root of the thigh (close to the vulva) or a portion of the contralateral areola. The skin removal on this area leaves a small incision practically imperceptible and of minor importance on the root of the thigh. For the nipple, we generally use local tissues with which we perform the central elevation. We can also use the tatoo of the areola.

In reconstructions with TRAM, normally we have sufficient tissue to reconstruct the entire breast. In rare cases of very thin patients, with not enough tissue volume, we associate silicone implants that will provide the volume desired.