Free Muscle-sparing TRAM St. Louis – Breast Reconstruction Technique Missouri

Candidates for this procedure include patients who are having or have had a mastectomy or are unhappy with a previous expander/implant reconstruction. Patients with previous radiation are also excellent candidates for this procedure. If radiation is anticipated, then the TRAM will be delayed until after radiation is completed so as not to permanently damage the abdominal tissue from the radiation. In this situation, a temporary implant, or expander, may be used to preserve as much skin as possible on the breast until the final reconstruction is done.

Poor candidates for this surgery are women who are significantly obese (BMI >35) as this may lead to problems with abdominal hernias and/or poor blood flow to the abdominal tissue which can result in failure. Also, patients with previous abdominal surgeries may not be candidates depending on the location of their scars. Patients who smoke have a greater risk of complications due to poor blood flow and coughing. Finally, women who have little fat on their lower abdomen may not be able to attain the breast size they desire. Fat transfer to the flap can be done in some instances to increase the volume of the flap in a later surgery revision.

Dr. Cabbabe will ask that you refrain from taking any aspirin, plavix, Coumadin, ibuprofen or any other type of blood thinner. If you are taking chemotherapy, this will need to be finished prior to surgery.

You will be admitted to the hospital for two to four nights. Pain medication and antibiotics will be prescribed. An epidural may be used depending on the situation. There may be some numbness on the breast and abdomen which gradually improve with time. Most patients are able to shower within 24-48 hours. Drains will be placed inside the breast and in the abdomen for approximately 2 weeks. Recovery is approximately 4 to 6 weeks. There may be some residual weakness of the abdominal wall after surgery. Most patients are kept on aspirin for 6 weeks after surgery to prevent clotting of the vessel anastomosis/connection.

A fluid collection can form in the abdomen where the tissue was removed after the drains have been removed. This occurs in up to 20% of patients and requires a simple aspiration of the fluid with a syringe and needle in the office. The blood vessels to the tissue flap can be injured as a result of the procedure or the blood vessel connection can clot after surgery, requiring an emergent return to the operating room to salvage the reconstruction. The flap could lose blood flow, turn black and require further surgery to remove. Patients can have some abdominal weakness for the first few months but this gradually improves. Bulging of the abdomen may occur after surgery due to weakness and require further surgery.