thumb|Post-operative state after Transverse Rectus Abdominis Myocutaneous flap(TRAM).Another possible donor site for breast reconstruction is the abdomen. The TRAM (transverse rectus abdominis myocutaneous) flap or its technically distinct variants of microvascular "perforator flaps" like the DIEP/SIEA flaps are all commonly used. In a TRAM procedure, a portion of the abdominal tissue, which includes skin, subcutaneous fat, minor muscles, and connective tissues, is taken from the patient's abdomen and transplanted to the breast site. Both TRAM and DIEP/SIEA use the abdominal tissue between the umbilicus (or "belly button") and the pubis. The DIEP flap and free-TRAM flap require advanced microsurgical technique and are less common as a result. Both can provide enough tissue to reconstruct large breasts and are a good option for patients who would prefer to maintain their pre-operative breast volume. These procedures are preferred by some breast cancer patients because removal of the donor site tissue results in an abdominoplasty (tummy tuck) and allow the breast to be reconstructed with one's own tissues instead of a prosthetic implant that uses foreign material. That said, TRAM flap procedures can potentially weaken the abdominal wall and torso strength, but they are generally well tolerated by most patients. Perforator techniques such as the DIEP (deep inferior epigastric perforator) flap and SIEA (superficial inferior epigastric artery) flap require precise dissection of small perforating vessels through the rectus muscle and, thus, do not require removal of abdominal muscle. Because of this, these flaps have the advantage of maintaining the majority of abdominal wall strength.
thumb|Post-operative state after Transverse Rectus Abdominis Myocutaneous flap(TRAM)Another possible donor site for breast reconstruction is the abdomen The TRAM (transverse rectus abdominis myocutaneous) flap or its technically distinct variants of microvascular "perforator flaps" like the DIEP/SIEA flaps are all commonly used In a TRAM procedure a portion of the abdominal tissue which includes skin subcutaneous fat minor muscles and connective tissues is taken from the patient's abdomen and transplanted to the breast site Both TRAM and DIEP/SIEA use the abdominal tissue between the umbilicus (or "belly button") and the pubis The DIEP flap and free-TRAM flap require advanced microsurgical technique and are less common as a result Both can provide enough tissue to reconstruct large breasts and are a good option for patients who would prefer to maintain their pre-operative breast volume These procedures are preferred by some breast cancer patients because removal of the donor site tissue results in an abdominoplasty (tummy tuck) and allow the breast to be reconstructed with one's own tissues instead of a prosthetic implant that uses foreign material That said TRAM flap procedures can potentially weaken the abdominal wall and torso strength but they are generally well tolerated by most patients Perforator techniques such as the DIEP (deep inferior epigastric perforator) flap and SIEA (superficial inferior epigastric artery) flap require precise dissection of small perforating vessels through the rectus muscle and thus do not require removal of abdominal muscle Because of this these flaps have the advantage of maintaining the majority of abdominal wall strength