Breast Reconstruction by Tram Flap Cases

Often overlooked in TRAM flap reconstruction is the potential secondary benefit of abdominal wall contouring.
Here the patient is shown in the top row of photos before a bilateral mastectomy, and then in the bottom row of photos after the completion of breast reconstruction.

The abdomen is flatter, shapelier, and overall more attractive. The breast has been lifted in the reconstruction to make this patient feel better about her body after a bilateral mastectomy. An amazing but certainly welcome paradox.

2nd photo – Shows a close-up before and after

3rd photo – Shows a close-up of how my technique for nipple and areola reconstruction creates a very natural appearing nipple-areola complex

Case Study Categories: Breast Reconstruction by Tram Flap.

For this patient, bilateral breast cancer provided a unique opportunity to dramatically improve the appearance of her abdomen. Previous abdominal surgery left her with a double pouch separated by an unaesthetic scar.

The abdominal tissue was divided in half to make two breasts. She is shown in the top three views before bilateral mastectomies. She is shown in the bottom three views after bilateral breast reconstruction, including nipple reconstruction and pigmentation.

Case Study Categories: Breast Reconstruction by Tram Flap.

This case also reveals the uniqueness that TRAM flap can bring to breast reconstruction. This case was quite challenging. A moderately sized superficial tumor far from the nipple complex dictated that a moderately wide skin excision be performed. TRAM flap was uniquely qualified to reconstruct her.

Top: Pre-op views

Bottom: Post-op views

In order to completely camouflage the upper mastectomy hollowness, the TRAM flap was purposely made larger than the original breast. Therefore, the right breast had to be increased in size. This was simply done by a breast augmentation for symmetry.

Case Study Categories: Breast Reconstruction by Tram Flap.

This case demonstrates the incredible ability of TRAM flap to naturally re-create a breast.

The top photo shows the patient before the bilateral mastectomy.

The bottom photo shows the patient after bilateral TRAM flap breast reconstruction with nipple reconstruction and pigmentation. (Remember that photos done early after pigmentation show a brighter nipple/areola color than would be seen weeks later)

Case Study Categories: Breast Reconstruction by Tram Flap.

The psychology of breast cancer, mastectomy surgery, and immediate reconstruction cannot be overemphasized. This case shows a patient who had obviously been wearing a bikini before her post-op photos (bottom row), as well as afterward. This shows the power of reconstruction and its ability to restore a sense of pride, wholeness, and well-being.

Case Study Categories: Breast Reconstruction by Tram Flap.

The ability of TRAM flap to reconstruct a breast, after unilateral (single-sided) mastectomy and to match the opposite side, is unequivocal.

Here, a patient with left breast cancer is shown:

Left Column: Pre-op

Middle Column: Same patient after TRAM flap to reconstruct a mastectomy defect.

Right Column: Final outcome, after nipple-areola reconstruction and pigmentation.

Case Study Categories: Breast Reconstruction by Tram Flap.

This patient presented with left breast cancer and chose to be reconstructed at the same time of the mastectomy, using her abdomen- TRAM flap. The bottom photos show her after the left TRAM flap reconstruction and the right breast lift for symmetry.

Case Study Categories: Breast Reconstruction by Tram Flap.

This case shows the versatility of TRAM flap reconstruction. This patient presented with left-sided breast cancer, necessitating a mastectomy. A variably-shaped skin island attached to the TRAM flap tissue reconstructed the left breast to a virtual mirror image of the unaffected, untreated right breast.

Top Row: Pre-op

Bottom Row: Post-op

In TRAM flap surgery, the reconstructed breast fell exactly like the normal breast. A superb outcome.

Case Study Categories: Breast Reconstruction by Tram Flap.

Clockwise from top left: Pre-op, before the bilateral mastectomy for breast cancer.

Bottom right: After the bilateral mastectomy

Bottom left: After the bilateral nipple-areola reconstruction.

A very fine aesthetic outcome. It is hard to imagine the significant deformity that would have otherwise been apparent from the bilateral total mastectomy.

Case Study Categories: Breast Reconstruction by Tram Flap.

Large-breasted women who have breast cancer and do not desire any treatment of the opposite breast may best be candidates for TRAM flap breast reconstruction.

This case shows a patient with DD cup breasts and left breast cancer.

Center views: After a total mastectomy and TRAM flap.

Right views: After nipple reconstruction.

A nice symmetrical outcome in a difficult case.

Case Study Categories: Breast Reconstruction by Tram Flap.