A muscle sparing transverse rectus abdominal muscle flap (MS TRAM) is when the surgeon takes only a part of the muscle from your tummy area. This creates a new breast shape and is usually done as a free flap operation.
This type of reconstruction may be suitable for women:
- with breasts of any size
- who do not want an implant
- who need to have both breasts reconstructed.
It may not be suitable for women who:
- have previous scarring on the tummy area
- are very slim and do not have enough tissue on their tummy
- have diabetes or other illnesses, such as rheumatoid arthritis or other autoimmune diseases, that interfere with blood circulation to their tissue.
- You may have a patch of skin on your breast which is a different skin tone.
- You will have a scar across your tummy below your belly button, from hip to hip.
- Most operations using tissue from the tummy are successful. But they have a slightly higher risk of complications than operations using tissue from the back.
- Some women have some loss of sensation (numbness) in the tummy area.
Fluid under the wound (seroma)
TRAM flaps use one of the muscles from the front of the tummy (the ones that form the six-pack). These muscles are important for lifting and physical work. They also work with the back muscles. If they are weakened, you may get back pain and find some sports and physical activities more difficult. A physiotherapist may give you exercises to do to strengthen your tummy.
- A MS-TRAM flap uses only part of the muscle. Because of this, it is less likely to cause muscle weakness than a standard TRAM flap operation.
- In a DIEP or SIEA flap, no muscle is used. This preserves the strength of the tummy more.
Hernia or bulge in the tummy area
Some women develop a bulge or hernia in the tummy area. If a muscle is used in the breast reconstruction, there is a higher risk of this happening. But a bulge can develop after any type of flap surgery that uses tissue from the tummy.
Sometimes the surgeon will use a mesh to strengthen the abdominal wall. This is used to try to prevent a bulge or hernia. This mesh may be permanent, or it can be designed to dissolve away in time.
Below is a sample of the sources used in our breast cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
European Society for Medical Oncology. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of oncology 26 (supplement 5): v8–v30. 2015.
Morrow M, et al. Chapter 79: malignant tumors of the breast. DeVita, Hellman and Rosenberg’s cancer: principals and practice of oncology (10th edition). Lippincott Williams and Wilkins. 2014.
National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. July 2018.
Scottish Intercollegiate Guidelines Network. SIGN 134. Treatment of primary breast cancer: a national clinical guideline. September 2013.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Rebecca Roylance, Consultant Medical Oncologist.
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