TRAM Flap Breast Reconstruction

The Transverse Rectus Abdominis Flap, also known as the TRAM flap, is an autologous breast reconstruction option. The Transverse Rectus Abdominis muscle is in the lower abdomen between the waist and pubic bone. With the TRAM flap procedure, skin, fat and muscle in the lower abdomen is used to reconstruct the breast. A TRAM flap procedure is not ideal for everyone, so talk to Dr. Spear if you are interested.

FAQ

How long is my recovery?

You can expect to spend 1-3 nights in the hospital following this procedure. You will have some swelling and bruising of the abdomen. The swelling might persist for several weeks. You will have an abdominal binder in place, and should continue to wear it after you leave the hospital. This helps reduce swelling and protects your incision. After your drains are removed, you can switch to wearing a girdle-like garment. You can expect your reconstructed breast to be very swollen. Most often, dissolvable sutures are used along the incisions. It is important to make sure the abdominal binder stays below your breasts as not to interfere with blood circulation to the reconstructed breast. You should be able to resume normal activities in about a week. You may take small walks as long as you are not dizzy. Strenuous exercise, heavy lifting and abdominal exercises are restricted for 6 weeks.

How long will I be in pain?

You will have discomfort for a few days. Much of your discomfort will be in your abdomen. Tightness and soreness in the abdomen might persist for a couple of weeks. You will be given a prescription for pain medication to use immediately post-op, and can change to Ibuprofen or other over the counter pain relief after a few days. You may also have an On Q-pump, which will infuse medication into your abdomen to help with pain. This will be removed around five days post operatively.

How often will I need to come to the office for follow-up visits?

Your first post-op visit will typically be within three days after discharge from the hospital. We will check your incisions, integrity of the flap, observe for signs of infection, and monitor your recovery. We will then see you on a weekly basis until your drains are ready to be removed. Sometimes, after the drains are removed, you can develop a collection of fluid in your abdomen called a seroma. This is not serious, but can be uncomfortable and put stress on your incision. If this occurs, we will remove the fluid with a small needle, in the office. This might have to be done once or twice weekly until the body absorbs the fluid. This is not a painful procedure.

When can I go back to work?

Most patients take 4-6 weeks off of work. If your job requires physical labor, you should allow yourself six weeks before returning to work, or return with lifting restrictions.

When can I drive?

You can drive as soon as you are off of the narcotic pain medication and feel alert enough and physically able to do so.

What medications will I be on after surgery?

You will be given prescriptions for pain medication; usually Percocet and Vicodin. You may take one or the other to control your pain. A prescription for Zofran is also given; you can have it filled if you need to. This can be used to control post-operative nausea and vomiting that some patients experience after anesthesia. An oral antibiotic might also be prescribed.

Will I have dressings/bandages to change?

You will have Dermabond, an adhesive glue covering your incisions. Your incisions can get wet. Do not apply any ointment or scar products to your incision until discussed with our office. A medicated dressing will be placed over your incisions on your reconstructed breast. After you leave the hospital, you can change this daily until your first post-operative appointment.

Will I require a blood transfusion?

Bleeding is always a potential risk of surgery. The TRAM flap procedure does not require a blood transfusion because blood loss is kept to a minimum during surgery. However, if you are adamant about blood donation or refusal, please let Dr. Spear and the nurses know prior to surgery.

When can I have sex?

You may have sex when you feel comfortable enough. However, we suggest waiting a week to give your incision time to heal. Too much stress on your abdominal incision can cause it to reopen. Also, immediately post-op, avoid manipulation of the reconstructed breast.

Will I have scars?

You will have one long incision across your abdomen, usually extending upward from hip to hip. You will also have two small incisions from the drains; usually in or just above your pubic hairline. You will also have an incision inside your belly button. The scars on your breast will vary depending on the amount of skin replaced.

Will I have drains?

Two drains are usually necessary in the abdomen and one drain in the reconstructed breast to help collect fluid that accumulates following surgery. These are left in place when you leave the hospital. You will need to empty and measure the output of the drains at least twice daily. The nurse will show you how before you leave the hospital. The amount of time the drains stay in place varies with each person. Usually they stay in place for 1-2 weeks. They are concealed pretty well when secured under loose garments.

When can I shower?

Sponge bathe until you are seen for your first post-operative visit.

Will I have to wear a special garment?

Following surgery, you will be given an abdominal binder to wear. This goes over your incision and lower abdomen. We suggest wearing this around the clock for about two weeks. After that, you can switch to wearing a girdle to help with swelling and contour.

How do I prevent constipation?

Narcotic pain medication can cause constipation. We recommend taking Colace or Pericolace. This medication is available over the counter at the pharmacy. You should begin taking this medication when you get home, and continue as long as you are on the narcotic pain medication. Increasing your fiber intake, eating fruits and vegetables, and drinking plenty of fluids also helps. If constipation becomes a serious problem, we suggest either a Dulcolax suppository or drinking Milk-of-Magnesia.

What if I cannot urinate?

Following anesthesia, some patients have difficulty urinating. If you go home and are unable to urinate within six hours, you might need to be catheterized. Go to the Emergency Room—either Georgetown or one that is closer to your home. Patients are usually able to urinate after the medication leaves their system.

How can I reach someone, after office hours if I have a problem?

If you have a problem and the office is closed, you may contact the Plastic Surgery fellow or chief resident. You will be given their pager number after surgery.

Do my sutures need to be removed?

Dr. Spear usually uses dissolvable sutures. They are not noticeable, and are absorbed by the body. You will have one suture holding each drain in place that will be removed with the drain.

When can I travel?

You may travel as soon as you feel physically able to do so. However, you may feel uncomfortable riding in a car for long periods of time within the first two weeks of surgery. We will also want to see you in the office on a weekly basis for the first 2-3 weeks.