While expander and breast augmentation surgery is a great option for some women, others may choose to undergo breast reconstruction with a flap, making use of their own tissue to recreate their breast.
The TRAM flap (transverse rectus abdominus myocutaneous flap) uses a patient’s lower abdominal skin and fat to reconstruct the breast. There are many variations of this type of surgery with multiple names, but the basic idea is this: During this surgery, the skin and fat of the lower abdomen is moved to the position of the breast. It is either rotated up with some of the abdominal muscles (a pedicled TRAM flap), or it is brought up into position and then blood vessels are sewn together to provide a blood supply (a free TRAM flap).
Other variations involve sparing the abdominal muscles partly or completely (the muscle sparing TRAM flap, and the DIEP flap). Regardless of which is used by your surgeon the abdominal tissue is transferred to your chest to restore the shape of your breast. The abdominal incision is then closed much as an abdominoplasty would be, leaving you with both a reconstructed breast and a tummy tuck. The surgery generally takes 3-6 hours and requires a few days stay in the hospital. Many women are able to return to simple activity within the week, and most women can resume full activities within 4-6 weeks.
The second stage of this reconstruction involves restoring the nipple and areola. Skin from the central portion of the breast is used to recreate the nipple. This is performed a few months after the original surgery, either in the hospital or as an office procedure. Once your surgeon has surgically created the nipple and areola, many women go on to have the area tattooed so that the color match is natural.