The tissue may be sculpted by folding or the surgeon may divide the flap in 2, as in a bilateral reconstruction, and stack the flaps for projection. Contraindications TRAM flap operation is major surgery not to be undertaken lightly by patient or surgeon. Experience with these procedures over the past 15 years has identified certain characteristics that place patients at higher risk for complications. In addition, anything that causes small vessel disease, such as the medical conditions listed above or cigarette smoking, may cause complications in the transferred tissue and in the abdominal donor site. In instances where the above characteristics contraindicate TRAM flap, use another method of reconstruction.
Consultation is required for the patient to understand the magnitude of the intended procedure.
Discussion should include possible complications and necessary scars, and the patient should have the opportunity to view pictures of an average TRAM flap result. Some patients find it helpful to speak to a prior patient who was once in a similar situation. Answer all questions to give the patient realistic expectations. Preoperative laboratory examination is directed by the patient s medical condition. TRAM flap Perform TRAM flap at mastectomy or afterward.