What is included in postoperative care following TRAM breast reconstruction?

Updated: Jul 28, 2021
  • Author: Michael R Zenn, MD, MBA, FACS; Chief Editor: James Neal Long, MD, FACS  more...
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Answer

An uncomplicated TRAM flap requires 4-7 days of hospitalization. Ambulation begins on postoperative day 1.

To remove tension on the abdominal closure, maintain the patient in a flexed position at the waist for the first few days. She can stand completely upright by the end of the first week. Drain tubes are necessary and usually are in place for 1-2 weeks.

The patient requires 6 weeks to 3 months to regain her energy level and resume normal activities.

Full range-of-motion exercises for the shoulder begin at 10-14 days postsurgery.

The patient may resume abdominal exercises in 6 weeks, not to include "sit-ups" until further abdominal healing has occurred at approximately 6 months postoperative.

Anesthesia occurs at the mastectomy site and central abdomen, which resolves over the next 6-12 months. Degree of sensory reinnervation to the TRAM flap varies and is patient dependent.

As a result of the tight closure of underlying muscle fascia of the abdomen, most patients experience a tight feeling for many months that is not "painful" in the classic sense but nevertheless can be disabling for up to 1 year in occasional patients.

Patients with preexisting back pain may have an exacerbation of this pain from the procedure and may want to consider an alternative procedure, such as implant reconstruction.

Prolonged convalescence and discomfort coupled with a cancer diagnosis may be depressing and emotionally draining.


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