After the tissue is lifted up, we identify the blood vessels that attach to the skin and fat underneath and then trace them down. Then what we do is remove a small piece of cartilage from the chest area, identify the blood vessels in the chest, and then under the microscope we hook up the blood vessels from the buttock tissue to the blood vessels in the chest. Blood vessels are usually about two millimeters, maybe three millimeters for a vein, which is not that big. We use an operating microscope and a suture that's finer than hair to suture the blood vessels together. It's actually easier than recovering from a procedure where skin and fat are removed from the abdomen.
Most people stay in the hospital two to three days depending on how they feel.
And most are feeling pretty good and back to doing lighter everyday type of activities within about three weeks. At times we can't do a free TRAM or a DIEP flap because some people just are too thin in the abdominal area, have had liposuction or a tummy tuck done, or have multiple scars in the abdominal area. If that's the case, most people have enough fat in the buttock area. Some of the contraindications for doing a regular TRAM flap used to be if you were a smoker, diabetic, or overweight. However, because of the types of reconstructions we do now with microsurgeries and free flap reconstructions, it turns out the blood supply is actually better once you get the tissue hooked up.