TRAM Breast Reconstruction Surgery

TRAM Breast reconstruction surgery to recreate a breast after breast tissue has been removed as part of cancer treatment (mastectomy). There are many kinds of breast reconstruction procedures. One type is called TRAM (transverse rectus abdominis muscle). TRAM reconstruction uses tissue and muscle from your abdomen (flap procedure) to reconstruct your breast.

There are two types of TRAM flaps:

• Attached (pedicle) TRAM flap.
  • Tissue and muscle stay connected to their original blood supply.
  • Fat, skin, blood vessels, and muscle from your abdomen are tunneled under your skin to your chest to rebuild your breast.
• Free TRAM flap.
  • Abdominal tissue is disconnected from its blood supply and moved to your chest to rebuild your breast.
  • Blood vessels from the flap are reconnected to the blood vessels in your chest using very precise instruments and an operating microscope (microsurgery).

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Any future plans to get pregnant. This procedure may not be recommended for women who want to have children.
• Any history of radiation therapy to your chest.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Pain.
• Infection.
• Bleeding.
• Scarring.
• Loss of feeling in the breast or the place in your abdomen where muscle tissue is removed (donor site).
• Bulging of an organ or tissue through a weak spot in the abdominal muscles (hernia).
• Abdomen weakness.
• A breast that looks or feels different than expected. There may be lumps in the reconstructed breast.
• Blood clots or blocked blood vessels.
• Death of the tissue flap. This would require another surgery to remove it.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
• Ask your health care provider what steps will be taken to lower your risk of infection. These may include:
  • Removing hair at the surgery site.
  • Washing skin with a germ-killing soap.
  • Antibiotic medicine.
• Ask how your surgical site will be marked or identified.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given one or both of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• Your surgeon may mark your breast to plan the incisions and reconstruction.
• Your surgeon will make an incision to remove a section of skin, fat, and supporting structures from your abdomen.
• The abdominal tissue will be placed on your chest and shaped into a breast mound.
• If you are having a pedicle TRAM flap procedure, your blood vessels will be checked for blood flow (patency).
• If you are having a free TRAM flap procedure, your blood vessels will be reconnected with microsurgery.
• Your incisions will be closed with stitches (sutures).
• One or more tubes may be put in place to drain the incision sites as you heal.
• Incisions will be covered with a bandage (dressing) and a pressure wrap.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until you leave the hospital or clinic.
• You will be given pain medicine as needed.
• You will be encouraged to get up and walk as soon as you can.
• Your IV can be removed when you are able to eat and drink.
• You may have a drainage tube in place for 2–3 days. This tube prevents a collection of blood (hematoma) from developing in the breast area. Before you go home, you will be told about caring for the drain.
• A pressure bandage may be applied for 1–2 days to prevent bleeding or swelling. Ask your health care provider how to care for your pressure bandage at home.

Summary

• Breast reconstruction is surgery to recreate a breast after breast tissue has been removed as part of cancer treatment (mastectomy). One type of procedure to recreate a breast is called TRAM (transverse rectus abdominis muscle).
• Breast reconstruction is generally safe. However, some problems may occur, including pain, bleeding, infection, blocked blood vessels, death of tissue, or loss of feeling in the breast or abdomen (donor site).
• Before the procedure, follow instructions from your health care provider about eating and drinking restrictions and any changes to medicines and activities.
• Your health care provider will perform the reconstruction using an attached TRAM flap or a free TRAM flap.

TRAM Breast Reconstruction, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Drainage.
• Swelling.
• Pain and tenderness. You will be given pain medicine as needed.
• A breast that has an abnormal shape or feel. The shape and feel of the reconstructed breast will improve over time as the swelling decreases.
• Discomfort while standing or sitting. This is caused by the incision in your abdomen. This will improve in about a week.
• Tiredness.
• Scarring.

You may need up to 6–8 weeks to recover.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not take medicines that contain aspirin and ibuprofen until your health care provider says that you can. These medicines can increase your risk of bleeding.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
  • Take an over-the-counter or prescription medicine for constipation.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider. Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area and donor site every day for signs of infection. Check for:
  • Redness.
  • More swelling or pain.
  • Warmth.
  • Blood or more fluid.
  • Pus or a bad smell.
• Do not take baths, swim, or use a hot tub until your health care provider approves.

Activity

• Avoid exercises that could strain your abdomen muscles (such as sit-ups and aerobics) for 6 weeks after surgery, or as told by your health care provider.
• Avoid sitting for a long time without moving. Get up to take short walks every 1–2 hours. This is important to improve blood flow and breathing. Ask for help if you feel weak or unsteady.
• Do not lift your arms above your head for 4–6 weeks or as told by your health care provider.
• Avoid lifting, pushing, or pulling anything that is heavier than 10 lb (4.5 kg) for 3 weeks, or as told by your health care provider.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing after surgery. If you need help quitting, ask your health care provider.
• If you were sent home with a surgical drain in place, follow instructions from your health care provider about:
  • How to empty it.
  • How to care for it at home.
• Avoid tight-fitting clothing around your abdomen and chest.
• Wear a supportive undergarment or bra as directed by your health care provider.
• Consider joining a support group for people who have had breast reconstruction. Talk with your health care provider or a counselor if you are having problems coping with your recovery and emotions.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have any of these at your incision area or donor site:
  • Redness.
  • More swelling or pain.
  • Blood or more fluid.
  • Pus or a bad smell.
• Your pain is getting worse or is not going away.
• You notice unusual lumps or changes in the area where you had surgery.

Get help right away if you:

• Feel short of breath.
• Have an irregular heartbeat.
• Have chest pain.

Summary

• After the procedure, it is common to have pain, tenderness, swelling, and a breast that does not feel or look normal for a few weeks.
• Take over-the-counter and prescription medicines only as told by your health care provider. If you are taking prescription pain medicine, take steps to prevent or treat constipation.
• Follow instructions from your health care provider about how to take care of your incision area and donor site. Watch for signs of infection.
• Wear a supportive undergarment or bra as directed by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.