Repair of TRAM Hernias

Correcting TRAM Bulges and Hernias

TRAM Hernia Repair

The traditional approach to natural tissue breast reconstruction is the pedicled TRAM (transverse rectus abdominus myocutaneous) flap. Unfortunately, because one or both of their rectus muscles have been sacrificed, women that have had pedicled TRAM flap breast reconstruction have a high risk of developing lower abdominal weakness and contour deformities. These contour abnormalities include unnatural protrusions and bulges as well as areas of laxity that can develop into hernias. In our practice, we avoid utilizing the pedicled TRAM flap in breast reconstruction and favor newer microsurgical techniques, such as the DIEP, SIEA, and muscle-sparing TRAM free flap procedures that preserve the rectus muscle. These microsurgical procedures allow us to minimize the risk of hernia.

To help women who have developed TRAM related hernias, we offer our unique abdominal wall reconstruction procedure that is customized to each patient. If you have developed a TRAM bulge or hernia, you can arrange a consultation with our surgeons at Aesthetic Plastic Surgery, PC.  During a visit with our surgeons, we will explain how our procedure can provide a stable hernia repair while improving abdominal wall contour.

TRAM Hernias - Defining the Problem

For many surgeons, TRAM related abdominal bulges and hernias can be difficult to repair. Unlike more common types of lower abdominal hernias, TRAM hernias are more difficult to repair because there is missing muscle and fascia from the initial TRAM flap surgery. Also, with TRAM hernias, the contour abnormalities and extent of abdominal protrusion can be severe. Unfortunately, many women are being told that they have no good options for repair of their TRAM hernias or for correction of their associated abdominal deformities.

Approaches that have been described for TRAM hernia repair include simple repair with suture plication or placement of mesh over the hernia. Both of these approaches have a high incidence of hernia recurrence.  More complicated methods of repair involve placing mesh inside the abdomen, either with an open incision or with laparoscopy. Unfortunately, these approaches do not reliably correct the contour deformities due to TRAM hernias. 

TRAM Hernia Repair - Our Unique Approach

At Aesthetic Plastic Surgery, PC, our surgeons have devised a unique and reliable method of abdominal wall reconstruction for women with TRAM hernias. In our procedure, not only are TRAM related hernias reliably repaired, but the associated abdominal wall bulges are corrected. For the past decade, we have had the opportunity to help women with TRAM bulges from our region as well as women from throughout the country.

Our technique, which involves an extended mesh repair with external oblique muscle reinforcement, was first published in the Annals of Plastic Surgery in 2009 and has been presented at plastic surgery conferences locally and nationally. For all of our TRAM hernia repairs, we utilize a team approach, working together with a general surgeon who is an expert in hernia repair.

In our procedure, the healed TRAM incision is reopened and the area of hernia and bulging is identified. Since areas of weakness can vary in different patients, this approach allows the repair to be customized to the needs of each individual. Once different areas of weakness are specifically addressed, both external oblique muscles are elevated and an extended mesh reconstruction is completed. The mesh is secured to ligaments as well as to bone on the lower abdominal wall and the external oblique muscles are then advanced over the mesh to reinforce and strengthen the repair. This approach avoids the need for entering the abdominal cavity while repairing the hernia and correcting bulging of the abdominal wall.

Risks and Benefits

We are able to safely and reliably correct abdominal deformities related to TRAM hernias by utilizing our extended mesh repair with external oblique muscle reinforcement. The risks of this procedure, including infection, bleeding and wound healing problems, are all low. In addition, given the strength of this type of abdominal reconstruction, the risk of recurrent hernia remains very low . Unlike some other approaches to repairing TRAM hernias, our unique method allows for repair of the hernia as well as correction of areas of prominence and bulging.


Any woman that has had TRAM flap breast reconstruction and has developed any abdominal wall deformities or hernias may be a candidate for our method of abdominal wall reconstruction.

Contact Aesthetic Plastic Surgery, PC

If you have TRAM related abdominal weakness and bulging, or if you have a TRAM hernia, we can help. Our reconstructive surgeons  have treated numerous patients with TRAM hernias, including many that have traveled to see us from throughout the country. If you have been told that repair of your TRAM related hernia is too difficult, let us evaluate you for our effective and reliable technique. To arrange a consultation at our Long Island, New York plastic surgery office, please contact our team of plastic surgeons today.


Aesthetic Plastic Surgery, PC Great Neck Office 833 Northern Blvd
Ste 160

Great Neck, NY 11021
(516) 498-8400

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