Dr. Nancy Van Laeken M.D., F.R.C.S.C.


Tram Procedure

(Transverse Rectus Abdominis Myocutaneous Flap)
Autologous Breast Reconstruction


Autologous breast reconstruction refers to the creation of a new breast mound from the patient’s own tissue. This involves using the patient’s own muscle, skin and fat from another part of the body. In the tram, the donor site is from the lower abdomen and the tissue between the umbilicus and the pubis is used. The most common technique for this procedure is the pedicle method. This means, the muscle and tissue are harvested and tunneled upwards from the donor site to the breast region while still attached to its own blood supply. Typically, there is enough tissue to reconstruct large breasts. The abdominal incision extends from hip to hip and the contour of the lower abdomen is improved, offering the affects of a “tummy tuck”. It is important to note however, this may weaken the abdominal muscles, therefore, a piece of surgical mesh is placed over the defect and sutured in place to prevent greater muscle weakness and hernias.

The goal of breast reconstruction is to match the affected breast as closely as possible in shape and size to the natural breast. In the case of bilateral reconstruction (both breasts), this procedure allows for greater flexibility in size, selection and symmetry. Dr. Van Laeken will help you determine if this is an appropriate procedure for you. She will review the surgical techniques and share with you, before and after photos at the time of your consultation.

This procedure can be done either at the time of the mastectomy (immediate reconstruction) or later (delayed reconstruction).

Breast reconstruction makes many women feel better about their appearance however, it is important to be realistic about the expected outcomes. A reconstructed breast won’t look exactly like your original breast nor will the sensation be similar. In general, flap procedures behave like the rest of your body. Consequently, the graft may enlarge or shrink as you gain or lose large amounts of weight.

The completed reconstruction can take 9-12 months and requires 2 operative procedures.


Candidates for a Tram Procedure

  • Patients who have had a mastectomy
  • Patients with an adequate amount of abdominal tissue
  • More likely offered to women requiring radiation as a reconstructive option
  • Non-smokers
  • Women who have any of the following conditions may not be candidates for tissue flap reconstruction:
    – Diabetes
    – Vascular Disease
    – Connective Tissue Disorders

Procedure Video

Breast Reconstruction


View before and after photos



Email: info@vanlaeken.com