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Transverse Rectus Abdominis Myocutaneous Flap (TRAM)


A Transverse Rectus Abdominis Myocutaneous flap (TRAM) is a breast reconstruction procedure using transversal skin and subcutaneous tissue below the navel for use as a donor area for a new breast. Small blood vessels of the straight abdominal muscle (rectus abdominus) supply this tissue with blood. When the tissue is transposed, the abdominal muscle with blood supply is used as a "stem" for blood supply to the flap. Following this, it is necessary to reinforce the abdominal wall with an artificial net.

Relocation of autologous tissue for breast reconstruction is resource-demanding and is reserved for a minority of patients. In patients who have been given radiation therapy, it may be difficult to achieve good results with implants. Using autologous tissue is more appropriate in such situations. This method is also appropriate for younger patients, patients with poor cosmetic outcome after breast-sparing surgery, or problems with earlier implant reconstruction. This method is also a good option for patients who do not wish to have implants. Autologous tissue can also be relocated and combined with an implant. 


  • Reconstruction of the breast after curettage/mastectomy

  • Patient wish for reconstruction with autologous tissue


  • Smoking/nicotine during the last 3 months
  • BMI > 28
  • Other serious comorbidity


  • Better quality of life
  • Anatomical symmetry 

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