The most common donor site for autologous reconstruction is the lower abdomen, between the umbilicus (belly button) and the pubic area. The skin and fat in this region resemble the natural consistency of the breast and many women have excess tissue in this region. Removing it has the additional benefit of improving the aesthetic appearance of the abdominal wall.
There are a variety of ways to transfer this tissue and the TRAM (transverse rectus abdominis musculo-cutaneous) flap was first described in 1979. During the 1980’s and 1990’s this was the standard method of autologous breast reconstruction. Refinements in surgical technique now mean that it is possible to use this same donor area without sacrificing the underlying rectus abdominis muscle.