• Strict selection criteria are followed to determine suitability for Tram Flap reconstruction. You would not be able to have a Tram flap reconstruction if you are overweight or too thin, a smoker, suffer from any chronic medical or psychological illness.
• The new breast will not have sensation. The nerves in your original breast have been removed thus it will feel numb.
• The Tram flap requires a longer surgical and recovery time of 4 to 12 weeks as you have to recover from both a tummy-tuck and breast surgery.
• The procedure is essentially a tummy tuck. You will have all the advantages and disadvantages of a tummy tuck. The scar will be from hip bone to hip bone and the navel will be placed in a new position.
• The site were the flap is turned over and tunnelled to the breast will form a visible bump which, in time as the muscle atrophies decreases in size but will never completely disappear. You may require additional surgery to decrease the hump.
• The procedure creates weakness of the anterior abdominal wall due to removal of one of the rectus muscles. This may lead to the formation of an abdominal hernia which requires surgical repair. For this reason most surgeons will use a mesh to reinforce the anterior abdominal wall.
• Complete failure of the TRAM flap is seen in 5%-10% of cases. In such a case although the residual tummy tuck remains your will have to have additional procedures to remove the failed flap as well as a healing period before another reconstruction may be attempted.

The procedure is associated with 2 anaesthesia and the second procedure is a long procedure of approximately 4 – 6 hours thus and increase risk of developing deep vein thrombosis in an already high risk patients

Below follows a list of the more common complications.

Local Complications:

• Infection-This ranges from superficial wound infection easily treated with antibiotics or a deeper infection in cases of flap loss and complete separation or opening up of the abdominal flap
• Bleeding-Small amounts of bleeding will be drained by the drains left behind. However occasionally a large collection of blood may form which may become infected or cause compression of adjacent tissue. In such a case the patient has to be returned to theater so that the wound can be reopened.
• Seroma-Clear fluid collects from the raw surfaces where the operation was performed, a normal response to injury.
• Flap Failure-Every flap needs a good blood supply, occasionally the flap does not receive all the blood in needs to stay alive and in such a case the flap my fail. The failed flap would have to be surgically removed and further options for breast reconstruction would need to be discussed.
• Revision Surgery-After the muscle is moved from the back to the front, it changes in size over the next few months. The reconstructive surgeon may have reconstructed the breast slightly larger than the opposite breast to compensate in the shrinkage in size. However with time there may be a discrepancy in the size of the breast which will require additional surgical procedure to best match the sizes.

Systemic complication…. your body

• Fluid and electrolyte abnormalities
• Deep vein thrombosis
• Post operative lung complications

Long term and cosmetic complications… the way it looks

• Asymmetries of the breasts
• Poor scarring
• Fat necrosis, hard lumps of tissue
• Pain, from many causes including muscles spasms and nerve injury
• Secondary procedures to improve the appearance eg. fat fills
• Hernia or bulge at the abdominal donor site

A Tram flap is a big procedure. It is important to understand theThank you for reading this pamphlet. We hope that we have explained the procedure in an understandable manner and have address some of your questions. Please feel free to ask any additional questions or concerns.