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Case Study: Tram Flap

Breast Reconstruction by Tram Flap – Case 1

This case shows a patient who is undergoing the process of breast reconstruction. She is shown before nipple reconstruction and after nipple reconstruction. The subtle increase in volume overall in the post-op viewS (arrows) comes from fat grafting done at the time of nipple reconstruction.

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Breast Reconstruction by Tram Flap – Case 2

This patient underwent bilateral mastectomy and bilateral reconstruction with pedicle TRAM flaps. Later nipple reconstruction and fat grafting adds to the ideal outcome. An exceptional outcome in breast and abdomen.

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Breast Reconstruction by Tram Flap – Case 3

This patient presented with left breast cancer and after lumpectomy has a significant defect and asymmetry.  She underwent left mastectomy and I did a TRAM flap reconstruction with right breast lift.  Now her breast is much more symmetric.

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Breast Reconstruction by Tram Flap – Case 4

TRAM flap plus implants is a complex combination procedure few surgeons will perform. Here, this patient is shown after successful reconstruction after bilateral mastectomy.

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Breast Reconstruction by Tram Flap – Case 5

This case shows a patient after TRAM flap breast reconstruction for left mastectomy and post-surgery radiation. She developed severe radiation induced atrophy and contracture.

I released scars with micro release non-incisional techniques and fat grafting. She is shown with dramatic improvement. A fine outcome.

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Breast Reconstruction by Tram Flap – Case 6

This young patient is shown in the top row of photos prior to left total mastectomy for breast cancer and in the bottom row of photographs after left mastectomy, TRAM flap with implant under flap left breast reconstruction and right breast augmentation for symmetry. An outstanding cosmetic outcome with noticeably slimmer abdomen, fuller breast and near duplication of the right enhanced breast on the left side. Small B to Full C cup transformation.

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Breast Reconstruction by Tram Flap – Case 7

This woman faced a decision regarding management of her breast cancer. She was planning bilateral mastectomy. She had enough tissue in her abdomen for use in immediate reconstruction. Several months later a minor procedure to make nipples completed her reconstruction. Her abdomen is flat, she looks great and feels complete after her mastectomy. An ideal outcome.

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Breast Reconstruction by Tram Flap – Case 8

This patient is shown in the top row of photos just prior to undergoing right mastectomy for breast cancer. The bottom row shows her after mastectomy, tram flap reconstruction of the former right breast site, nipple reconstruction and left breast mastopexy (lift) for symmetry.

Note that the new nipple (right breast) closely resembles the left nipple (her own natural nipple).

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Breast Reconstruction by Tram Flap – Case 9

This case follows the course of a woman who presented to me with the bilateral absence of breast after double mastectomy. Her deformity (typical) can be quite challenging. A bilateral Tram Flap with implants (a difficult combo few plastic surgeons will do) gives her a fine outcome. (She is shown in the various stages of recovery)

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Breast Reconstruction by Tram Flap – Case 10

This women presented with a plan to undergo right mastectomy for breast cancer (multifocal). A tram flap was done to reconstruct her right breast immediately.

She is shown in left column of 2 photos before mastectomy, the middle row of photos after the initial tram flap, and the right column 2 photos after nipple reconstruction and the pigmentation.

Note, the natural, aesthetic outcome here. Remember this was a mastectomy for breast cancer, but you can’t tell that at all.

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