TRAM flap procedure restores breasts of cancer patients

Nov. 11, 2004 -- When Mary Kay Gaydos-Gabriel was diagnosed with bilateral breast cancer three years ago, she was shocked because she had no family history of the disease.

A mastectomy was required to remove the cancer, and she was faced with the emotional trauma of losing both breasts.

Keith Brandt performs a breast reconstruction using the traverse rectus abdominus myocutaneous (TRAM) flap procedure, which allows reconstructive surgeons to use the patient's tissues to recreate a natural breast.

Fortunately, oncologists at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington School of Medicine in St. Louis explained to Gaydos-Gabriel that reconstructive plastic surgeons could perform a technique called the TRAM (traverse rectus abdominus myocutaneous) flap procedure, which allows surgeons to use the patient's own tissues to recreate a natural breast.

"When the two procedures are done simultaneously, the patient is rid of the cancer while being spared the emotional trauma of being without a breast," says Keith E. Brandt, M.D., associate professor of plastic and reconstructive surgery. "In one fell swoop, you can get rid of the disease and get a completely natural reconstruction — along with a free tummy tuck."

While oncologic surgeons at Siteman perform a mastectomy, Brandt steps in and harvests the tissue of the TRAM flap, which will be used to create a natural breast.

During the procedure, Brandt removes an oval section of skin, fat and muscle from the lower abdomen wall, along with the arteries and veins that supply those tissues.

The blood vessels are reattached, and the tissue is shaped into a natural-looking breast.

After the breast settles, patients can opt for nipple reconstruction a few months later. That procedure uses skin from the breast to create a nipple and then is colored with a tattoo technique.

Keith Brandt

Although the 1998 Federal Breast Reconstruction Law requires insurance providers to pay for reconstruction in connection with mastectomies, only 15 percent of American women have reconstructive procedures following mastectomy, according to the American Society of Plastic Surgeons (ASPS).

And the numbers drop significantly for African-American, Hispanic and Asian women.

A recent ASPS study reported that whether a woman chooses to have breast reconstruction following mastectomy is largely influenced by her race, geographic location and stage of the disease.

Fortunately, at Washington University — one of a handful of centers in the Midwest that offers immediate breast reconstruction at the time of mastectomy — 60 percent of breast cancer patients have reconstructive procedures.

"Losing a breast after a mastectomy can take a heavy emotional toll," Brandt says. "As reconstructive surgeons, sometimes our job is to 'fill holes' resulting from trauma or tumor resection. But in breast reconstruction, we have the opportunity to rebuild part of the patient. It's very rewarding to help patients get back to normal again."

Gaydos-Gabriel says she's thrilled with the results of her reconstructive TRAM flap procedure and feels like she was spared much of the psychological trauma that accompanies breast cancer.

"I think I was really saved from a lot of the emotional ordeal that results from losing your breasts," she says. "I love that the results are so natural."

Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked second in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.