Pedicled TRAM flap breast reconstruction remains an effective means of recreating a soft, ptotic, breast after mastectomy for cancer. Advances in technique and preoperative markings have led to increased efficiency and safety.

TRAM flap reconstruction involves the transfer of lower abdominal skin and subcutaneous fat based on the superior epigastric vessels. Common risk factors for complications from pedicled TRAM flap reconstruction include smoking and obesity. Initially described by Dr. Hartrampf in 1982, the TRAM flap uses the excess skin and subcutaneous fat that is routinely discarded in a cosmetic abdominoplasty for breast reconstruction. Hartrampf observed that the lower abdomen could survive as an island of tissue as long as the attachments to the rectus sheath and underlying rectus muscle were kept intact. Because of the dual blood supply of the rectus abdominus muscle, the TRAM flap can be raised either as a pedicled flap based on the superior epigastric vessels.