Complications are more common for women who smoke or are very overweight.
Build-up of fluid under the donor wound site (seroma)
This sometimes happens soon after the operation, but usually gets better within a few weeks. This is more common after a pedicle TRAM flap operation than after free flap operations, where the blood supply to the tissue is cut and reconnected.
Hernia or bulge in the tummy area
Taking muscle from your tummy can weaken the tummy wall, and some women develop a bulge or hernia in the tummy area. There is a greater chance of this happening after a pedicle TRAM flap, as more muscle is taken. To reduce the risk, you will have mesh put into your tummy wall to support it. Hernias are less common after a free TRAM flap and are rare after a free DIEP or SIEA flap reconstruction.
Your surgeon and nurses will keep a close check on the new tissue in the reconstructed breast in the first few days after the operation. They will want to be sure that its blood supply is working well. If there are any signs of a problem, you may need to go back to the operating theatre to have it checked. This is done to make sure the new breast tissue stays healthy and heals well. About 1 in 8 women (12%) who have a flap made from their tummy tissue may need one of these 'second check' operations during the week after their surgery. It’s more likely to be needed after a free flap operation than after a pedicle TRAM flap.
Loss of all or part of the new breast
Most operations are successful, but occasionally the blood supply to the reconstructed breast is not good enough and the flap fails (dies). This happens to about 1 in 500 women (0.2%) who have a pedicle TRAM flap and to about 2 in 100 women (2%) who have a free flap procedure. Sometimes a small area of the new breast is lost soon after the operation. Another operation may be needed to improve the appearance of the breast.
Fat necrosis can sometimes happen after abdominal flap surgery. It occurs when fatty tissue doesn’t have a good enough blood supply. Fat necrosis feels like a firm lump in the reconstructed breast. If you feel a lump in your reconstructed breast it will need to be checked out. Smaller areas of fat necrosis can often be absorbed by the body with time. But, sometimes you need further surgery to remove the area of fat necrosis and improve the appearance of the breast.
TRAM flaps use some of the muscles from the front of the tummy (those that form the six-pack). These muscles are important for activities such as lifting and more physical work. They also work with the back muscles. This means if they are weakened you may get back pain and find some sports and physical activities more difficult. You may be given exercises to do to get back full strength of the tummy. If you have reconstruction using a DIEP or SIEA flap no muscle is used and this preserves the strength of the tummy more.