TRAM flap


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.

One of the benefits of a TRAM flap breast reconstruction is that the breast(s) can be reconstructed without needing implants. Some women also consider it a ‘bonus’ that the tummy is left relatively flat after removing the tissue flap (a ‘tummy tuck’ effect).

A TRAM flap breast reconstruction may NOT be the best option if you:

  • have had surgery to the abdomen in the past; the similar DIEP flap or other tissue flaps may be suitable alternatives
  • have poor blood flow through blood vessels
  • have chronic medical conditions (such as some severe respiratory or circulatory problems)
  • are very slender (because there may not be enough abdominal tissue for this procedure).

Breast reconstruction techniques which use tissue flaps that rely on a supply of blood may not be suitable for people who smoke. Smokers should stop cigarette smoking and nicotine substitutes for at least 4 weeks before the scheduled operation. This may be a consideration when deciding whether immediate or delayed breast reconstruction would be best for you.

Transverse Rectus Abdominis Musculocutaneous (TRAM) flap breast reconstruction


Woman after mastectomy: showing TRAM and surrounding tissues in preparation for breast reconstruction.

  • A mastectomy site
  • B right transverse rectus abdominis muscle
  • C left transverse rectus abdominal muscle
  • D segment of abdominal tissues: skin and fat, to be transferred along with muscle to create the new breast


A woman showing the lines of TRAM reconstruction incisions.

  • A lines of reconstructed breast incisions
  • B circle of re–positioned "belly button" incision
  • C line of abdominal surgery incision

Figs. 8.6, 8.7, 8.9, 8.10, 8.13, 8.14 (pp.58-62) from Breast Cancer: The Facts by C. Saunders & S. Jassal (2009), By permission of Oxford University Press,

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