Hello - I had a tram flap three years ago. I’m currently doing research to find out how many other people have had the same dillema as myself (that’s how I found this website) to determine where to go from here. I’m hoping mine is a ‘worst case’ scenario.
You see, at first my tummy was very tight on the lower abdomen, but slightly bulgey at the navel area. It looked like the abdomen of a very young child. I figured it would smooth out over time. Next thing I knew, I’d gotten a hernia in the area the doctor had removed the muscle for the tram. It wasn’t until that point that the plastic surgeon told me (as if I should instinctively know this) that I was never to pick up anything weighing more than 20 pounds (a bit under 10 kg)! No one had ever told me my entire lifestyle would have to change after the tram flap, nor had they warned me not to pick up things. Normal things (a bag of groceries, a basket of laundry, the vacuum cleaner, etc) weigh more than 20 pounds. So I had to have hernia surgery.
After that surgery I was very careful not to pick up anything of any weight, but it’s not just weight that’s a problem…even getting in and out of the car, walking up stairs carrying anything, certain movements, can still strain that area. Eventhough I was careful, one year later, another hernia developed and I had to have a second hernia repair. This time I insisted on having physical therapists work with me to strengthen what was left and to learn how to move/work more carefully to not put a strain on the muscle. That went well and my tummy actually flattened a bit for the first time. But even still, I’ve never had a ‘waist’ since the tram surgery…just an infantile shaped belly.
The physical therapy was a few months back, and I (stupidly) slacked off and haven’t kept up with the exercises (most were modified Pilates using a big ball). Now I seem to be developing a new problem. The upper abdomen (right where the ribs separate) sometimes feels like it’s tearing away. I’ve yet to see my surgeon to find out what’s going on.
Overally, I regret having had the tram flap. Not because the surgery itself is bad per se. And since mine was done at the same time as my masectomy, I felt ‘whole’ and all. (Though a bit like Frankenstein’s sister – the tram cut me from hip to hip.) I was always a large size and the idea of having a ‘tummy tuck’ sounded like the only bonus in the whole cancer/masectomy thing. Being large-breasted, lacking one would be pretty obvious. (A small-breasted friend had a masctomy just a few months prior to mine and she never had any reconstruction or prosthesis – and no one noticed.) It just was never well explained to me and no one ever took my lifestyle into consideration. I’m not a sit-on-the-sofa sort of person, I’m active and have always done heavy yard work and house work myself. Now I can’t even carry simple groceries in the house or take a roaster out of the oven or vacuum without asking for assistance. I’m not sure if the surgeon botched the job or if it’s my fault (for not knowing I wasn’t ever to lift things).
And…I’m sorry if this isn’t a positive answer to your post. I guess my answer would be to be sure to consult your physician/surgeon before exercising. Hopefully your case is nothing like mine, but be careful. I was glad to get some ‘safe’ exercises from the physical therapists, but now I’m beginning to wonder if even those were safe enough.
Never think the doctor will think you’re stupid. It’s ALWAYS best to get as much information as possible. They’ve heard those questions before anyway. 
Be well.
RobinM