TRAM flap = Transverse Rectus Abdominus Myocutaneous flap

The indications for this surgery were that I had recurring tumours in my left breast which had already been radiated.

I stole this picture from somewhere, I think the Mayo Clinic website. Conveniently it shows a left reconstruction which is what I had.

A hole is cut in the skin around the tummy. Mine included the belly button. Actually my belly button should have gone into the rubbish bin, because it's really no use after you're born, but the plastic surgeon tells me people get disoriented without their belly button, so he stuck it back in another place, now slightly off-centre... Ho hum... I suppose I am happy I still have a belly button.

This diagram shows the breast skin as having been removed, which mine wasn't. I had an instant reconstruction, which saves the skin.

Two teams of surgeons were involved, but only one team of nurses and theatre staff which provides continuity between the two surgical teams.

The first team are the breast surgeons who remove the breast tissue, including the nipple, but leaving the skin intact.

The plastic surgeon then takes over and starts to disconnect things in the tummy area, including skin, fat and muscle, and move them around under the skin to follow the course of the blue arrow and fill the empty bag of skin where the breast was. Then he re-attaches the tissue to blood vessels in the chest area using microsurgical techniques.

The new breast had a white disc in the middle where the original nipple used to be. A disc of skin was saved from the bit that was taken from the belly area, and used to fill the hole where the nipple was.

I believe the whole process, including removal of the breast, took about 6 or 7 hours. I don't recall anything between about 10am and 6pm.

It takes a while for everything to settle into place, but after the new breast healed and the stomach recovered from this massive surgery, the plastic surgeon started to ask if I wanted a nipple. "It's part of the deal," he said. But I wasn't interested. I was up to my eyebrows with hospitals. However, after three years I changed my mind and I now have a plastic nipple, which is another story I will tell another time.

If you can stand it, here is a video of a live TRAM flap. Her diseased breast was removed on a previous occasion, but it's still the same process.