TRAM (Transverse Abdominal Myocutaneous) flap is an out-dated technique of breast reconstruction which should only be performed in absolutely exceptional cases.
In this procedure, skin and fat is extracted from the lower abdomen, the underlying straight abdominal muscle (rectus abdominis) is completely peeled off and severed. The tissue thus extracted is pushed upwards to restore the breast. The function of the abdominal muscle is completely lost, the abdominal muscle is "degraded" to an "umbilical cord" which should supply the skin and fat piece. The function of the abdominal muscle is thereby completely lost. The result is a weakness of the abdominal wall, i.e. the abdomen becomes spherical, and the affected women experience a significant loss of strength in the trunk muscles.