Usually as a result of breast cancer, a woman may have one or both breasts removed. Other traumas to the body can also take place that result in a loss of breast tissue. In these instances, rebuilding one or both breasts can return the body to its original condition or even to a perceived enhanced appearance. This surgery involves a fairly complicated procedure that uses the muscles of the abdomen. The abdomen has two large, parallel muscles, called rectus abdominus. When only one breast is reconstructed, relinquishing one of these muscles poses no risk of impairment to a woman’s health or physical activity. However, when both breasts need to be reconstructed, using both muscles can cause abdominal weakness, so that some movements (such as sitting up from lying down) are harder to do.
During breast reconstruction, the abdominal muscle is used to move the skin and fat from the abdomen to the chest for the construction of a new breast. This flap is referred to as the TRAM flap, or the Transverse Rectus Abdominus Muscle flap. The skin, fat tissue, and the muscle are cut away intact from the abdomen while remaining attached to the body. Because the TRAM remains attached to the body, blood vessels remain unbroken, allowing the tissue to remain vital and functioning. The TRAM is then repositioned underneath the skin and adjusted and shaped via an opening where the original breast used to be. It is an amazing operation, and many of the same risks associated with abdominoplasty (a tummy tuck, describer earlier in this chapter) can occur. However, once complications are resolved, a woman has the benefit of a more natural looking body shape and a tummy tuck at the same time.