TRAM flap

概述

A TRAM flap is a type of breast reconstruction. It uses skin, fat, and some or all of a lower belly muscle to make a new breast after a mastectomy. A mastectomy is surgery to remove all breast tissue from a breast.

During TRAM flap surgery, tissue from the belly is moved to the chest. TRAM stands for transverse rectus abdominis muscle. The name comes from the rectus abdominis muscle and other tissue used in the flap. This tissue may stay attached to its blood supply. Or it may be removed and reconnected to blood vessels in the chest.

Because TRAM flap reconstruction uses your own tissue rather than a breast implant, it's called autologous reconstruction.

The reconstructed breast may not look or feel exactly like your natural breast. For many people, though, reconstruction can improve the way they feel about their body after breast cancer treatment.

Types

There are different types of TRAM flap surgery. The type that's right for you depends on your body, your health, how much tissue is needed and your surgeon's experience.

• Pedicled TRAM flap. In a pedicled TRAM flap, the tissue stays attached to its blood supply. The surgeon moves the tissue under the skin to the chest to create the new breast. Blood vessels do not need to be reconnected.

• Free TRAM flap. In a free TRAM flap, the surgeon removes the tissue from the belly and reconnects its blood vessels to blood vessels in the chest. This surgery usually takes a little longer than a pedicled TRAM flap. But it gives the surgeon more flexibility when shaping and placing the tissue.
• Muscle-sparing free TRAM flap. This type of TRAM flap removes less of the lower belly muscle than a traditional TRAM flap. Keeping more muscle may help your belly stay stronger after surgery.

• Bilateral TRAM flap reconstruction. This type rebuilds both breasts after a double mastectomy. Because tissue is taken from both sides of the lower belly, recovery may take longer. Some people also have more weakness in the belly than after reconstruction on one side.
• Supercharged or bipedicled TRAM flap. Sometimes the surgeon uses more blood vessels or tissue from both sides of the belly. This can improve blood flow or provide more tissue for reconstruction. These procedures are more complex and are used only when more tissue or extra blood flow support is needed.

目的

TRAM flap surgery rebuilds the shape of a breast after a mastectomy. It is one type of breast reconstruction that uses your own tissue instead of a breast implant.

Many people choose this type of reconstruction because they want to use their own tissue. Others choose it because the breast can look and feel more natural.

Breast reconstruction is a personal choice. Some people choose to have reconstruction at the same time as their mastectomy. This is called immediate reconstruction. It also can be done months or years later, after cancer treatment is complete. This is called delayed reconstruction. Some people choose not to have reconstruction at all.

Immediate reconstruction may reduce the number of surgeries you need. Delayed reconstruction may be a better choice if you need more cancer treatment or have other health concerns. Both can be good options.

Your care team can explain your options and help you decide what's right for you. A TRAM flap may be an option if you have enough skin and fat in your lower belly to create a breast. Your surgeon also considers your health, any previous belly surgery and other conditions that could affect healing or blood flow.

If radiation therapy for breast cancer is part of your treatment plan, your care team talks with you about how it may affect reconstruction. Radiation can affect the timing of surgery.

Compared with breast implant surgery, TRAM flap reconstruction is a more complex surgery. It usually takes longer and requires a longer hospital stay and recovery. Because it uses your own tissue, the reconstructed breast changes naturally with your body over time. Some people also prefer to avoid long-term issues related to breast implants, such as implant replacement.

A TRAM flap is just one of several types of breast reconstruction that use your own tissue. Your surgeon may recommend another option, such as a DIEP flap. DIEP stands for deep inferior epigastric perforator.

Like a TRAM flap, a DIEP flap uses tissue from the lower belly. Unlike a TRAM flap, a DIEP flap keeps most of the belly muscle in place. Keeping more muscle may help your belly stay stronger after surgery.

No one type of breast reconstruction is right for everyone. The best choice depends on your health, your cancer treatment plan and what matters most to you. Your care team can explain the benefits and drawbacks of each option and help you make a decision.

风险

Like all major surgeries, TRAM flap breast reconstruction has risks. Most people recover without serious complications. Your surgical team watches you closely during and after surgery to find and treat problems as early as possible.

Possible risks of surgery include:

• Bleeding.
• Infection.
• Slow healing of the surgical cuts, called incisions.
• Fluid buildup, called a seroma.
• A collection of blood under the skin, called a hematoma.
• Side effects from general anesthesia, such as nausea, vomiting or confusion.

Risks related to the flap include:

• Reduced blood flow to the flap, which can lead to partial or complete flap loss.
• Tissue death, called flap necrosis, caused by reduced blood flow.
• Fat necrosis, which can cause firm areas or lumps in the reconstructed breast.
• Slow wound healing.
• Changes in feeling the breast or belly, including numbness.
• The need for more surgery to treat a complication or improve how the reconstructed breast looks.

Removing part or all of the lower belly muscle can make your belly weaker. Some people develop a bulge or, less often, an inguinal hernia. Your risk depends on how much muscle is removed, your health and whether one or both breasts are rebuilt. Muscle-sparing techniques may lower these risks, but they don't eliminate them.

Some surgeons use surgical mesh or other materials to help support the belly during healing. These materials are not needed for every TRAM flap procedure. Like any implanted material, they can become infected, although this is not common. Your surgeon decides whether extra support is right for you.

Smoking, obesity, diabetes, previous radiation therapy for breast cancer and conditions that affect blood flow can raise the risk of healing problems.

If you are having a free TRAM flap, your care team checks the blood flow to the reconstructed breast after surgery. If blood flow becomes reduced, you may need treatment or another operation to improve circulation and help save the flap. Early recognition and treatment improve the chance of a successful outcome.

If radiation therapy is part of your treatment plan, your care team talks with you about how it may affect reconstruction. Radiation can increase the risk of scar tissue, slow healing and skin changes. Even so, many people have successful reconstruction after radiation therapy.

Before surgery, your care team reviews your medical history and talks with you about your risk factors. Following instructions about smoking, wound care and activity restrictions also can help support healing.

如何进行准备

If you're thinking about TRAM flap breast reconstruction, you meet with a plastic surgeon who specializes in breast reconstruction. If possible, your plastic surgeon and breast surgeon work together to plan your care. During your visit, you talk about the benefits and drawbacks of TRAM flap reconstruction and other reconstruction options.

Your plastic surgeon reviews your medical history and examines you. The surgeon checks whether you have enough tissue in your lower belly for reconstruction. You also talk about your health, any previous belly surgeries, your cancer treatment plan and what matters most to you. These factors help your surgeon recommend the type of reconstruction that's right for you.

Your surgeon explains the different types of TRAM flap reconstruction, including pedicled, free and muscle-sparing surgeries. Depending on your body and your goals, your surgeon also may talk to you about other options, such as DIEP flap. You also may look at photographs of reconstruction results and discuss whether more surgery later may help improve breast shape, rebuild the nipple and areola, or improve symmetry.

Before surgery, your care team reviews your medicines, allergies and medical conditions. You may need to stop or adjust some medicines, especially those that increase the risk of bleeding. Always follow your surgeon's instructions about which medicines to stop and when to stop them.

If you smoke, you need to stop before surgery. Smoking reduces blood flow, slows healing and increases the risk of complications. Your surgeon may recommend stopping smoking several weeks before surgery and avoiding all nicotine products during recovery.

If you have diabetes or another condition that affects healing, your care team may recommend improving blood sugar control or treating other medical conditions before surgery. Reaching a healthier weight also may help lower the risk of complications for some people.

Before surgery, ask your surgeon what to expect. You may receive instructions about:

• When to stop eating and drinking before surgery.
• Which medicines to take or avoid on the day of surgery.
• Bathing or using a special antibacterial soap before surgery.
• What to bring to the hospital.
• When to arrive for surgery.

These discussions can be overwhelming. Write down your questions and concerns before your appointments, and consider taking notes during them. It can be easy to forget important details when you're under stress.

Also consider bringing someone with you to your appointments. Having another person with you can help you understand and remember information about the surgery and recovery.

Plan ahead for your recovery. Most people stay in the hospital for several days after TRAM flap reconstruction. Arrange for someone to drive you home and help with daily activities during the first week or two after you leave the hospital. You also may need to take time away from work and avoid heavy lifting while you recover. Your surgeon tells you when it's safe to return to your usual activities.

Ask any questions you have before the surgery. Knowing what to expect can help you prepare for surgery and feel more confident in your care.

可能出现的情况

What happens during TRAM flap surgery depends on the type of reconstruction you have and whether it is done at the same time as a mastectomy or later. Your surgeon explains what to expect before, during and after surgery.

Before the procedure

You arrive at the hospital several hours before your operation. A member of your care team reviews your medical history, medicines and allergies. You may have an intravenous (IV) line placed in a vein so you can receive fluids and medicines during surgery.

Before surgery, your plastic surgeon may use a marker or some type of pen to carefully outline the areas of your breast and lower belly that are involved in the reconstruction. These markings help guide the surgery.

TRAM flap surgery is done using general anesthesia. This means you are in a sleeplike state and don't feel pain during surgery.

During the procedure

The length of TRAM flap surgery varies. It depends on the type of TRAM flap, whether one or both breasts are being rebuilt, and whether reconstruction is done at the same time as a mastectomy. Free TRAM flap surgery usually takes longer than pedicled TRAM flap surgery because the surgeon reconnects the blood vessels.

During surgery, the plastic surgeon removes skin, fat, and some or all of the lower belly muscle. The tissue is shaped to create a new breast.

If you have a pedicled TRAM flap, the tissue stays attached to its blood supply. The surgeon moves it under the skin to the chest to create the new breast.

If you have a free TRAM flap, the surgeon removes the tissue from the belly and reconnects its blood vessels to blood vessels in the chest with microsurgery.

In some cases, a breast implant may be used with a TRAM flap to create the desired breast size or shape. Some people also choose more surgery later, such as nipple reconstruction or surgery on the other breast to improve symmetry.

After the procedure

After surgery, you spend time in a recovery area while your care team checks your breathing, blood pressure, pain and the blood flow to the reconstructed breast. If you had a free TRAM flap, your care team checks the flap often during the first few days. Early treatment is important if blood flow becomes reduced.

Dressings cover your incisions. You also may have one or more drainage tubes in your breast or belly to remove fluid while you heal. The drains usually stay in place until the amount of drainage decreases. Before you go home, your care team shows you how to care for them.

You receive medicine to help control pain. Your care team also encourages you to begin moving when it is safe. Getting out of bed, walking short distances and slowly increasing your activity can help lower the risk of complications and support recovery.

Most people stay in the hospital for a few days after surgery. How long you stay depends on the type of reconstruction you have, your health and how you're healing.

For several weeks after surgery, you can expect soreness, swelling and tiredness. You may feel more tired than usual as your body recovers.

Your belly and reconstructed breast need time to heal. Follow your surgeon's instructions about lifting, reaching, driving, exercise and returning to work. Your activity restrictions depend on the type of reconstruction you had and how you're recovering.

Call your care team right away if you have increasing pain, swelling, drainage, fever, or changes in the color or temperature of the reconstructed breast. Also call if you have any other symptoms that concern you. Early treatment can help prevent more serious problems.

Your recovery continues after you go home. At your follow-up visits, your care team checks how you're healing. The care team may remove drains or stitches if needed and answer your questions.

结果

Healing takes time. Swelling takes time to go down, and the reconstructed breast and belly need time to heal. Some people also choose more surgery to improve the shape of the breast, rebuild the nipple and areola, or improve symmetry.

The results of TRAM flap breast reconstruction are not immediate. Over several months, the shape of the reconstructed breast becomes more defined. Your care team checks how you're healing during follow-up visits.

Many people are pleased with the natural look and feel of the reconstructed breast. Reconstruction also may help some people feel better about their bodies after breast cancer treatment. Everyone's experience is different. Reconstruction can't restore the breast exactly as it was before surgery.

What TRAM flap reconstruction can do

TRAM flap reconstruction may:

• Help restore the shape of the breast after a mastectomy.
• Create a breast that looks and feels more natural than some implant-based reconstructions.
• Help your breasts look more balanced under clothing or a swimsuit.
• Reduce or eliminate the need for an external breast prosthesis.
• Change naturally as your body changes because it is made from your own tissue.
• Help you feel better about how your body looks after breast cancer treatment.
• Reduce some of the visible reminders of breast cancer treatment.

What TRAM flap reconstruction can't do

TRAM flap reconstruction cannot:

• Restore your breast exactly as it looked before surgery.
• Restore all of the natural feeling in the breast.
• Guarantee that both breasts will look exactly alike.
• Prevent future breast cancer or replace recommended follow-up care.

It is common for the reconstructed breast to have less feeling than a natural breast, especially during the first months after surgery. Some feeling may return as nerves heal. In some medical centers, surgeons reconnect nerves during reconstruction to help improve feeling. This is called flap neurotization. It is not done during every TRAM flap reconstruction and may not be available at every hospital.

Your reconstructed breast changes as your body changes. Gaining or losing weight may affect the size or shape of the reconstructed breast because it is made from your own tissue.

Some people choose to have additional procedures after the initial reconstruction. These procedures may improve breast symmetry and refine the breast shape. They also may reconstruct the nipple and areola, improve scars, or correct shape changes that develop during healing. Whether you choose more surgery depends on your healing, your results and what matters most to you.

Continue the follow-up care recommended by your care team after reconstruction. Your surgeon checks how you're healing, answers your questions, and talks with you about any future treatment or reconstruction options.

临床试验

探索 Mayo Clinic 的研究 测试新的治疗、干预与检查方法，旨在预防、检测、治疗或控制这种疾病。