Pedicled TRAM flap reconstruction after mastectomy

One of the most commonly used autogenous tissue reconstructions is the TRAM (transverse rectus abdominis myocutaneous) flap.
The drawing depicts reconstruction performed in a delayed fashion, which is sometimes necessary to allow chest wall radiation. However, the procedure can also be performed at the time of mastectomy to provide immediate reconstruction. Either the contralateral or ipsilateral rectus abdominis muscle can be utilized. Incision placement and size will vary based on the patient's body habitus. There are many ways to perform nipple reconstruction; one method is pictured here. The nipple is reconstructed after the flap heals and is then tattooed to the appropriate color so that there is symmetry with the contralateral breast.