The tissue is living and therefore may better resemble a natural breast. Since either type of TRAM can be performed the same day as a mastectomy, they are truly immediate reconstructions. However, the surgery is complicated and recovery is long. In a pedicle TRAM, a cut is made almost all around the transverse rectus abdominis muscle in the lower abdomen. The tissue remains attached via blood vessels to the abdomen and is repositioned through a cut in the skin at the site of the removed breast.
Problems can arise if the blood supply to the relocated tissue is cut off.
If this happens, part or all of the moved tissue will die off and have to be removed. For a woman who completely understands what's involved, the results can be excellent and this type or reconstruction can tolerate radiation better than an implant. With a free TRAM, the muscle is completely removed from the abdomen, then its blood vessels are reattached to new blood vessels higher up in the chest. This is very sophisticated microsurgery that requires special expertise. There remains a chance that the blood supply will be cut off, but the chance of the repositioned tissue dying is thought to be less.