All visitors are required to wear masks.

For COVID-19 safety, all visitors to ChristianaCare facilities and services are required to wear masks. This includes visitors who are vaccinated. Please read our visitor guidelines before arrival.

Masks required at outpatient locations; visitors and support persons limited

All visitors at outpatient locations must be masked in alignment with the masking guidelines on our visitation policy page here. Patients at ChristianaCare’s outpatient services are advised to come to their appointments alone unless a support person is absolutely needed. If a support person is needed, such as a parent, guardian or spokesperson, we highly encourage that the support person be vaccinated. Outpatient practices are not requiring vaccination or a negative COVID test for visitors at this time.

All hospital visitors required to be vaccinated or have a negative COVID-19 test.

  • Inpatients in our Christiana, Wilmington and Union hospitals may have one visitor daily between 10 a.m. and 8 p.m. The visitor must be 16 or older.
  • Patients having outpatient surgery may have one support person accompany them. Support persons must be 16 or older.
  • All visitors and surgical support people must show proof of vaccination OR a negative COVID-19 test within the prior 72 hours.

Before visiting, click here for more details about visitation.

Visit or for local vaccination and testing sites.

Plastic Surgery


TRAM (transverse rectus abdominis muscle) flap is a type of breast reconstruction surgery utilizing the lower abdominal tissue. In this flap procedure, we use transverse rectus abdominis, the “six pack” muscle in the central abdomen — along with skin, fat and blood vessels — to reconstruct the breast.

TRAM may be done as either a pedicle flap (which means the lower abdominal tissue remains attached to the body and is rotated under the skin to the chest area without cutting its blood supply) or a free flap (which means the lower abdominal tissue is disconnected from the body and reattached in the chest area).

Both a pedicle TRAM and a free TRAM require removal of the rectus abdominis muscle from its natural location which will result in loss of core strength. Usually a piece of synthetic mesh is required to repair the defect left after removal of the abdominal muscle, which can put patients at risk for abdominal hernias or bulges.

Who can have this procedure?

You may be a candidate for TRAM flap if you:

  • Have enough lower abdominal tissue.
  • Have not had previous surgery on your stomach.
  • Have had radiation to the chest wall in the past.

Things to Consider

  • Not all breast reconstructive surgeons have the expertise to perform this complex procedure. ChristianaCare’s Stephanie Caterson, M.D. is very experienced in flap procedures and has performed more than 500 TRAM flaps.
  • The loss of the rectus muscle can result in life long abdominal weakness.
  • TRAM flap leaves a long scar in the lower abdomen above the pubic line.
  • For more information, please visit the American Society of Plastic Surgeons website.

For more information or to schedule an appointment, call our office at 302-623-3605.