Disclaimer: I am going to include pictures that not everyone may want to look at because they are surgery related.
This past week, I had the privilege of seeing a TRAM flap procedure as part of a breast reconstruction. The patient received a modified radical bilateral mastectomy, one side was cancerous and they other she had removed prophylactically because her family has an extensive history of breast cancer.
The surgical oncologist got to work on the bilateral mastectomy while the plastic surgeon on the case started on the TRAM flap procedure. TRAM stands for transverse rectus abdominis which is a muscle in the abdomen that extends from the chest to the pubic bone. In this procedure, part the skin tissue and fatty tissue overlying the transverse rectus abdominis is used to reconstruct both breasts after the bilateral mastectomy is complete.
The first part the plastic surgeon had to complete was lifting the skin and fatty tissue up off the transverse rectus abdominis. Then, the blood vessels that supply the skin and fatty tissue had to be freed up from the underlying muscle tissue. This part had to be done very carefully because if the the blood supply to the tissue is disturbed, the procedure will fail. Once that part is complete and both breast are free of breast tissue, a tunnel is created between the abdomen and both sides of the skin that was surrounding the breast tissue. This part of the procedure was quite rough, it takes quite a bit of force to create the tunneling on both sides. After the tunnels are created the tissue that was covering each transverse rectus abdominis (there is one on each side of the belly button) was pushed through the tunnel into the area with the skin that was covering the breast tissue. Then it came time to shape the new breast, take out some tissue and align the skin left over from the bilateral mastectomy with the skin that was on the abdomen. After they made sure everything was aligned, both her stomach and both breasts were sutured up.
The whole surgery took almost eight hours. I stayed in the operating room for the whole length of the procedure. I was really impressed with the fact that I didn’t need to leave to go to the bathroom or leave to go eat or drink. I was so focused on what was happening in the procedure that I didn’t really realize how quickly time was passing outside of the operating room.
I am so grateful I was able to see that procedure because it was honestly one of the most amazing experiences I have had.
DON’T CONTINUE IF YOU DO NOT WANT TO SEE PICTURE FROM A SURGERY.
These are a few pictures of what the procedure sort of looked like. In the procedure I saw both breasts were constructed.