When is a TRAM flap not a TRAM flap?

I’ve just been given a date for an MX - 19th July. I can’t have immediate recon because I’m likely to need radiotherapy at a later date, but I can have an implant. The surgeon is talking about a TRAM flap reconstruction at some point but says that it’s not the one that takes the muscle, just one that uses fat from the stomach. Foolishly I didn’t ask what exactly this is called. Does anyone know about this and have any experience of it?


Macmillan do quite a good section on the recons available and what’s involved.


Hope this helps. Good luck


Hi - there is such a thing as a muscle sparing TRAM flap - thats what I had three weeks ago. I think it takes a little bit of muscle but mostly fat, and in my case (though not all as I understand it) they insert a mesh in the tummy wound as well. Hope that helps you?


Thanks Ruby,

That is helpful actually. I’ll ask if that’s what they’re talking about and about the mesh option. There’s so much information given to you that it’s only afterwards that I think of questions.

How are you feeling? Is three weeks long enough to not just be feeling sore?!

Thanks very much for replying.




I had a Tram Flap op using muscle in Dec 2010. I have recovered very well. I am back to doing everything I was before. My new boob looks very good and my flat tummy is a bonus.

Good luck with your op.

Take care

Carolyn x


Thanks everyone. That Macmillan site is very useful and I didn’t know about it so thank you. It seems that the non muscle one is called a ‘free’ flap and one from the abdomen is a ‘free DIEP flap’ . So I feel a bit better informed now thanks!

I’m dreading the whole thing really so it’s very comforting to read your posts, especially the ones saying that it’s going well. I’ve been fine for the last couple of months but now that I have the actual date I keep bursting into tears. I think it’s not so much the op - once you’ve got over the fact that a horrible mutilation is about to happen. But it’s the loss of control of your body and your life. And I find that hard to cope with. As everyone here says, reading what other women in the same position have to say is helpful and comforting beyond measure


Hi there

I have to decide on tram or ld flap…i posted a thread earlier.

I have no idea what to go for, but something tells me that tram will give the better result in the long run.

BUT, and it is a big but, i cannot face the thought of yet more surgery, and recovery…

Any words of wisdom would be gratefully received…

Naz xx


Yes that the one i am having on 14 july it is called a diep flap , I am have in mx and diep at the same time at the wellington in london hope all go well with you sue

Hi everyone,
I thought I will write my experience as it might help some people.
I just had unilateral diep at Royal Marsden (Fulham Road) on 4th july. Skin sparing mx and implant was done back in 2009. They took out the implant, did a capsulectomy and did a diep free flap. It was 5 hrs op and everything went very well. I was in ICU overnight for close observation and was moved to the ward next morning. I was in hospital for 6 days. Mobilised from next day of op. Came home last Sunday and gradually recovering. Initial 2 days were tough getting out of bed but painkillers and physiotherapists helped me. My ‘banana posture’ improved quite quickly. The backache which was due to the posture improved with mobilisation and infra-red heat massage (my husband brought the massager to hospital when I started to mobilise). My donor site (abdomen) is still quite numb and a bit tight but getting better everyday. Because they separate most of the abdominal wall from the underlying muscle to raise the flap, the upper and middle part of abdo feels strange, bit swollen and numb. With nerves regenerating in next few weeks this is supposed to settle down. The wound seems to heal well and boob looks great. I can’t have a full view because of some dressings that are to be left for 2 weeks. Taking shower with dressings on and drying them with hairdryer afterwards. Because I refused to have any lifting or reducing surgery on the other side they tried and seem to have achieved a good symmetry. I am taking things
slowly although walking frequently on the same floor because of tiredness which is getting better. It was a huge
decision for me and I was quite scared of recovery/complications etc but now I feel it was all worth it. Good luck.

Hi just read your blog. I am about to have a DIEP on Tuesday and am scared stiff. I think it is the recovery and will I wake up that’s worrying me most. But my boob is so uncomfortable (implant) I feel I have no choice. And I am sick of wearing awful bras as I still have to have a silicone thingy in my bra. I hope my recovery will be as good as yours. Thank you for sharing your experience.

Hi, I am about to have a DIEP this is using fat from tummy only, and not affecting muscle. I had an immediate reconstruction back in 2008 using an implant, but had to have radiotherapy, I was warned that it might encapsulate but psychologically needed something there. I went ahead with the implant and now have to have it removed. I am due in theatre on Tuesday (next week) scared but can’t wait to get this rock hard silicone implant out. It has also lost its shape and looks pretty hideous. And I still have to wear a prosthesis in my bra as the implant was too small. Not sure but think your op is similar. Good luck, tell us how you get on.

have you got a breast care nurse? my nurse came out to my home to discuss different operations with me on each occasion. After my first op WLE with auxillary node clearance i didnt get clearance so i opted for re-excision of margins with therapeutic mammoplasty (similar to a breast reduction) I still didnt get clearance so after chemo I underwent mastectomy with reconstruction opting for tram flap using abdominus muscle. The consultants are great but your mind is in such termoil that you dont always have time to ask what you want to or even think of the questions you want to until you get home, thats where your nurse comes in. They will go through the options with you and explain everything you need to know. I have no regrets what so ever with my choice, it is a big operation 9 hours and a slow recovery but the results so far (only 4 weeks ago) are amazing. Good luck XX

Hi Poonam
Hope your op went well. Mine was diep as well. Let us know how you are doing.
Best wishes.