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Center for Breast Reconstruction


TRAM breast reduction surgery utilizes the lower abdominal tissue.

What is TRAM Flap?

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.

Diagram of tram flap procedure

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.

Contact Us

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