TRAM Flap surgery is a reconstructive procedure performed after mastectomy to reconstruct the shape of the breast using muscle, fat and skin from the abdomen. Technically known as transverse rectus abdominus myocutaneous – named after the muscle taken from the abdomen to reconstruct the breast, TRAM Flap breast reconstruction is amongst one of the more popular methods for breast reconstruction after cancer.


TRAM Flap breast reconstruction can be performed using one of two methods:

  • Pedicle TRAM Flap Surgery

The pedicle TRAM flap technique transfers skin, fat, blood vessels and free muscle to the skin under the chest through an internal tunnel keeping all components intact.

  • Free TRAM Flap Surgery

The free TRAM flap technique is more advanced and requiring the skin, fat, blood vessels and free muscle to be removed and relocated and reconnected to the blood supply in the chest utilizing microsurgery. Many prefer this technique over pedicle TRAM flap because results are more natural.

Both methods are performed by making an incision along the bikini line from hip to hip and necessary skin, muscle and fat are relocated. This procedure also includes a tummy tuck to repair the area where the skin was removed, which is often an added benefit to this procedure.

In some cases breast implants are used to provide added fullness, particularly in those with less fat and tissue. Areola and nipple reconstruction is also available to restore the full likeness of the breast which consists of skin grafts and precise tattooing methods.

Dr. Smiley has undergone extensive microsurgery and breast surgery training and is dedicated to providing patients with natural looking results. With expertise in Free TRAM Flap surgery, the transferred fat and tissue will have good circulation which provides warm, soft breasts that move and look like a normal breast.


Ideal candidates for TRAM Flap breast reconstruction are of average weight and have stable health. Overweight patients are at a significant higher risk of hernia due to weakened muscle support. Underweight patients may also be non-candidates because patients need to have enough tissue to relocate. It is also absolutely necessary that patients do not smoke.

It is recommended that patients also complete radiation prior to undergoing TRAM flap surgery to ensure optimal results for both procedures. It is recommended that patients speak with Dr. Smiley prior to undergoing mastectomy. This way he will best be able to recreate the look of the original breast.

Breast Reconstruction with Insurance

As of 1998, insurance companies are required to cover breast reconstruction after mastectomy under the Women’s Health and Cancer Rights Act.

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