A TRAM flap breast reconstruction is a type of reconstruction where a patient’s lower abdominal skin and rectus abdominis muscle are used to create a breast shape. An elliptical piece of skin and fat (a skin paddle) is harvested from the lower abdomen and the rectus muscle used to carry the circulation to the reconstructed breast. The skin paddle is then tunneled under the upper abdominal skin and brought out at the mastectomy incision, allowing for the creation of a breast mound. The abdominal donor site is then closed by performing a modified tummy-tuck. The advantage of the TRAM is that the reconstructed breast can look and feel more natural than an implant-reconstruction, which may lead to better symmetry. The downside of a TRAM flap includes a scar from hip to hip (located very low on the abdomen) as well as around the patient’s navel. In addition, the TRAM is a three hour operation that necessitates a significantly longer recovery than an implant-based reconstruction. A brief hospital stay is usually required and full recovery takes 6-8 weeks.