Transverse Rectus Abdominus Myocutaneous (TRAM) Flap

In transverse rectus abdominus myocutaneous (TRAM) flap breast reconstruction, Mass General plastic surgeons use tissue from the lower abdomen to create a new breast after mastectomy.

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Mass General offers many options for breast reconstruction, including:

TRAM Flap Breast ReconstructionIf you have a mastectomy to treat or prevent cancer, breast reconstruction can surgically recreate a natural-looking breast. One option for breast reconstruction is a transverse rectus abdominus myocutaneous (TRAM) flap procedure.

In a TRAM flap, the surgeon first removes muscle, fat and skin from the lower abdomen. (If you lack sufficient abdominal tissue, areas such as the back, buttocks or thigh may be used instead.) The tissue, or "flap," is then transferred to the mastectomy area, where it is shaped to form a new breast.

A TRAM flap can be performed at the time of your mastectomy (immediate reconstruction) or at a later date (delayed reconstruction) for one or both breasts. This procedure produces: a breast that feels natural and a slimmer, flatter abdomen (as is seen in a tummy tuck).

Please note: A TRAM flap leaves a scar that extends along the lower abdomen, from one hip to the other. As a result, the recovery period may be longer than with breast construction with implants or tissue expanders.

Why Choose Mass General for Your Procedure

  • Harvard affiliated
  • 500+ breast reconstruction procedures per year
  • Coordinated care with your entire cancer team
  • Highly experienced in the latest procedures

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Two Types of TRAM FlapThe two types of TRAM flap breast reconstruction are the pedicle flap and free flap.

  • Pedicle flap: The blood vessels of the transferred tissue remain attached as the flap is tunneled under the skin of the upper abdomen into the breast pocket
  • Free flap: The tissue is removed from its blood supply and brought up to the breast pocket, where blood flow is restored by reconnecting the artery and vein using microsurgery. The flap is connected to the blood vessels under the arm, or under the breast bone.

Are You a Candidate for TRAM Flap Breast Reconstruction?You may be a good candidate for TRAM flap reconstruction if you:

  • Prefer to reconstruct one or both breasts using your own tissue
  • Have sufficient tissues in your lower abdomen to create one or both breasts
  • Have never had surgery on your abdomen
  • Are not a candidate for implant reconstruction
  • Have had radiation administered to your chest wall
  • Have had failed reconstruction using a breast implant


You may not be a good candidate for TRAM flap reconstruction if you:

  • Lack sufficient lower abdominal tissue to create acceptable breast volume
  • Have had abdominal surgery (e.g. an abdominoplasty)
  • Smoke (or quit smoking only recently)
  • Have diabetes
  • Are obese
  • Have an overly large abdominal pannus (hanging flap of tissue)
  • Cannot tolerate prolonged general anesthesia
  • Do not want a lower abdominal scar

Other Flap OptionsDepending on your particular situation, other flap options to create the new breast may include:


The TUG flap and SGAP/IGAP flaps are generally used with patients who lack enough abdominal tissue for the DIEP or SIEA flap. Breast Reconstruction at Mass GeneralOur plastic surgeons have extensive experience in all types of breast reconstructive techniques, including the newest and most innovative procedures. When appropriate, we combine techniques, using flaps, implants and nipple tattooing to achieve the most natural-looking outcome.

All forms of breast reconstruction after mastectomy have inherent risks, which will be fully discussed during your consultation.