Free vs. pedicled TRAM flap

have just been diagnosed with DCIS and will be having a full mastectomy and immediate reconstruction.

I have been told that I am suitable for a TRAM flap - thank god for that tummy that I always wanted to get rid of!

I could have the choice of a free or a pedicled TRAM flap - with a greater risk of rejection on the free TRAM flap, but likely abdominal weakness and back pain as after effects of the pedicled TRAM flap. I am fairly active and enjoy gardening and dancing, and really want to be able to do these after surgery without feeling limited as a result of having opted for the TRAM flap.

I have seen discussions on the impact of a TRAM immediately after surgery but can anyone tell me about how it all feels, say a year afterwards - pedicled or free?

Hi there,

I had a diep reconstruction which I believe is the same a a TRAM free, no muscle is taken from the stomach and they use micro surgery to re-connect its blood supply. Two years on from my op and have no adverse long term effects, no pain or problems with tummy, the scars are still visable but very low down and cannot be seen in the right underwear. My understanding is that diep or tram free are what the plastic surgeons term as the gold standard and give the best natural results, less associated hernia problems afterwards, but there is a higher risk of failure.

My advise would be to see if you can see a couple of surgeons, find out how often they do this type of op and what are their sucess rates, not foolproof but may help you decide what is best for you.

Good luck


hiya belle50,I am just over a year after surgery now and can do most things,just a little uncomfy in certain clothes,but as regards to normal things,I mow the lawn,carry my 7 yr old to bed if he falls asleep,most things really,i have been on the trampoline with him too but cant say i really enjoyed it,i think i am scared of falling or something and injuring myself.I had the pedicle tram flap,scars healed well and boobs look good. x

I had the free tram flap recon in July 2006 and after the op I had terrible back ache for a while and took things easy for quite a few months. It was great having hubby and son doing all the lifting for me.
Now life continues very much as before with the only difference being I now have a flat tummy and I now do all that lifting myself.
My recon boob looks great and the scars have faded to fine white lines. It is a big op but one I found worth going through.

Please ask why you can’t have a DIEP. It is superior to the Tram and doesnot compromise any muscle and althoug a longer operation, the recovery is quicker and less painful. In my area, they no longer do Tram either pedicle or free, unless there is an insufficient blood supply. This happens very rarely and usually only with people who have smoked. If your surgeon cannot do a Diep, you have the right to be refered to a surgeon who does.