TRAM FLAP: The use of transverse rectus abdominis myocutaneous (TRAM) flap surgery has spurred debate among physicians. Dr. Randolph Guthrie (Clin. Prof. Cornell Univ.) believes surgeons should not use stomach muscles to rebuild breast tissue. According to him, the risk of rebuilding breast using this method outweighs the benefits because women have died from vascular and lung blockages caused by relocating the abdominal fat. He criticizes plastic surgeons who tout a side benefit of the surgery as a tummy tuck, noting instead that many patients are left with 'dog-ear' scars and a larger waistline that before the surgery. The operation leaves an "ugly, scarred, misshapen blob of wide-pored abdominal flab that sits on the chest looking as though it had just come out of a crenelated Jello mold." Women who are dissatisfied with the results face additional risks if they choose corrective surgery, cannot do sit-ups or other abdominal exercises to relieve back pain, and are more and more vulnerable to abdominal hernias. Dr. E. Zoo (Prof. Surg. Illinois Univ.), past president of ASPRS, favors the TRAM flap.
C.O.S.S. comment: We have seen excellent results from TRAM flaps and we have seen disastrous results. The latter is most common. All the warnings about abdominal problems truly exist. In addition, the risk of infection is great and the mesh-net that is generally placed in the abdomen to replace muscle removed is another foreign object. It is extremely difficult to remove if there are problems. This type of surgery is very hard to endure for well persons, much less immune-system weakened women. Research this option very carefully before undergoing this procedure. There are additional risks, some of which are severe bleeding, shock, transference of cancer when done immediately after mastectomy, failure of the flap, infections (which are difficult to cure) and poor results.
Remember, there are several different types of flap procedures. There is the
superior gluteal flap (from the top of the buttocks), the other flap from the
bottom of the buttocks, the flap from the area of the saddle bags, and the
flap from the back of the chest (pectoral). Some flap procedures are free
flaps and some leave blood supplies and nerves connected. Free flaps
disconnect all blood supplies and nerves and then reconnect them with blood
supplies and nerves in the chest area. One abdominal flap procedure tunnels
up under the skin from the stomach to the breast area. This procedure may
seem like a good choice, but a large area of skin is disturbed and possibly
left open to infection. All of these flap procedures have good points and bad
points. For one thing, with flap procedures, no implant is used (except for
the mesh net used in most abdominal procedures). If one has very large saddle
bags or buttocks, there is the added benefit of a lift or reduction in size.
Flap procedures don't get hard (encapsulate). Flaps can look like normal
breast when done by a highly skilled microsurgeon. On the other hand, flap
procedures require very long operations, loss of blood is common (which can
require transfusions), the abdomen (if the donor site) can herniate, there are
very large scars, one has to be hospitalized for a much longer period of time,
etc. One must also be psychologically prepared for all of these factors in
order to be a candidate for a flap procedure. Also, for a flap procedure from
the abdomen, it is almost always necessary that no scars already exist in that
area (ie., tubal ligation, appendectomy, or Caesarian Section). Check them
all out before ever considering one and also talk to people who have had both
good and bad experiences with flap procedures. You owe it to yourself.
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