For some women, the transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction is the ideal operation for creating a replacement breast. An autologous breast reconstruction, i.e. using the patient's own tissue rather than inserting a breast implant, results in a breast with a natural feel and shape with minimal tissue rejection and infection rates.
It is superior to breast implant insertion as there is little adverse tissue reaction and no capsule formation which can be a complication of implantation. An added benefit is that this is in effect an abdominoplasty, or tummy tuck, as well as a breast reconstruction, and for many women this is a very welcome bonus.
The procedure is not suitable for anyone who has had previous abdominal surgery, because of scarring and reduced capillary blood flow in the tissues, or if the patient is slender enough not to have any excess abdominal tissue. It is not suitable either for women who smoke, again because of reduced blood flow. Otherwise this is a common procedure and can be used with beneficial effect for many women wanting breast reconstruction.
The Rectus Abdominis Muscle and its Structure and Function
There are two halves to the rectus abdominis muscle, one on each side of the linea alba which is a white band of connective tissue running along the length of the muscle (see the illustration below) and dividing the muscle up horizontally into sections. When the muscle is developed through exercise it becomes what is commonly known as the six-pack. It lies at the front of the abdomen and reaches from the symphysis pubis up to the lower edge of the chest. It provides strength and structure, and, along with the other muscles underneath and to the side in the abdominal wall, provides protection to the internal organs in the abdominal cavity.
Although it might seem as though taking muscle tissue may compromise the strength of the abdominal wall, post operatively a woman can with care slowly introduce a gentle exercise regiime to regain muscle strength. This will help to retain the new, flatter abdominal shape as well as prevent any future muscle weakness which might result in a hernia.
What is a TRAM Flap Breast Reconstruction?
This is a procedure which uses a flap of skin, fat and part of one side of the rectus abdominis muscle to provide the tissue bulk for a new breast. Through the abdominal incision which will eventually be the horizontal abdominal scar, the muscle, skin and fat is dissected in an oval shape, keeping its blood supply intact where possible. The whole flap is then tunnelled up through to the site of the mastectomy. The exposed skin of the abdomen becomes the skin of the new breast, and any skin lying below the edge of the new breast is trimmed away, leaving the rest of the tissue to provide bulk.
The procedure takes up to about three hours so as to construct a natural looking breast and to deal with both the breast and the abdominal dissection. Additionally, when the skin of the abdomen is stretched to tauten the abdomen and suture the incision, the navel may end up in the wrong place and so a new navel may need to be constructed.
Can a Breast Reconstruction be Done at the Same Time as a Mastectomy?
This is a decision that should be talked over carefully with the surgeons and the Breast Care nurse. Some women may decide that they do not want to be without a breast, whereas others may want to come to terms with the loss of a breast and come back for reconstructive surgery at a later date. This is a very personal choice.
In some cases it may be that the course of chemotherapy and radiation has been particularly demanding, or a mastectomy may need to be performed as an urgent case. Women in these situations may prefer to delay reconstructive surgery so that they are either fit and strong enough and the skin around the breast area is given a chance to heal properly, or they have had enough time to consider all the reconstructive options.
Any concerns or questions can be answered by the surgical team, or by the Breast Care nurses or a psychologist who can provide support during a challenging time. In the UK, asking for help in making these decisions is fully supported where such resources are available.
Also read Latissimus Dorsi Breast Reconstruction and What is a DIEP Flap Breast Reconstruction? for alternative methods of reconstructing a breast following mastectomy.
Disclaimer: This article is for information only. Women are advised to consult a plastic and reconstructive surgeon with a good reputation for breast reconstructions. In the UK, breast reconstruction is considered to be part of the NHS treatment made available following mastectomy and as such does not currently require a funding decision from the Local Health Authority.
Sources and further information:
- macmillan.org.uk
- breakthrough.org.uk
- bapras.org.uk - The British Association of Plastic, Reconstructive and Aesthetic Surgeons
Suzanne Bosworth - Suzanne Bosworth BA (Hons) - a professional writer published in magazines, journals and websites, specialising in arts, history and ...
