Reconstruction with pedicled (attached) TRAM flap

For breast reconstruction with a pedicled TRAM flap, a flap of tissue is cut out of the belly. The flap is made up of skin, fat, and a chunk of muscle. When surgeons cut the flap, they free the muscle from the belly but they do not detach it completely. Instead, they leave the muscle attached at the top, by the chest. They create a tunnel between the belly and the chest and pull the flap up through that tunnel. Then they attach the flap to the chest, and it becomes the new breast. The flap still has blood coming to it, because it was never completely detached. Later, surgeons can also reconstruct a nipple.