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Fox Chase Cancer Center Offers New Breast Reconstruction Procedure; "Free Tissue Transfer" Offers More Natural Looking Breast After Mastectomy

PHILADELPHIA (August 19, 2002)-Fox Chase Cancer Center is now offering the most advanced breast reconstruction procedure for women who have had a mastectomy for breast cancer. The procedure, called a free tissue transfer or free TRAM flap, uses a woman's own tissue and fat from her stomach (tummy tuck) to build a more natural-looking and natural-feeling breast.

"The restoration of the breast is an integral part of treating women for breast cancer," explained Neal S. Topham, M.D., of Holland, Pa., chief of plastic and reconstructive surgery at Fox Chase Cancer Center. "The goal with breast reconstruction surgery is to match the appearance of the remaining breast in size, shape and texture. The free TRAM procedure is a delicate surgery that yields excellent results and allows better symmetry using the patients' own tissue."

Despite tremendous advances in the treatment of breast cancer leading to breast-sparing procedures, nearly one-third of breast cancer patients still require a mastectomy. Many of these patients choose to have breast reconstruction.

"Many women are able to have breast reconstruction at the same time as their mastectomy, but they may opt to have the surgery later," said Topham. "Fox Chase Cancer Center can now provide women with the entire spectrum of reconstructive options, including implants, the TRAM flap procedure, free tissue transfer or a combination of these procedures. Each woman's circumstances will be different and choosing a procedure that is right for her is critical to a positive outcome."

Procedures using a woman's own tissue from her abdomen to reconstruct a breast are called TRAM (transverse rectus abdominus myocutaneous) flap procedures. For the free TRAM flap or free tissue transfer, the surgeon removes an island of fat, skin and muscle from the abdomen, shapes it into a breast and attaches it at the location of the mastectomy.

The procedure requires microsurgery-surgery under a microscope-to attach the artery and veins in the flap to blood vessels located in the chest wall. For some patients, the surgeon is able to modify the procedure to remove only skin and fat from the abdomen, preserving the abdominal muscle (perforator flap).

The TRAM flap procedure requires the removal of skin and fat from the stomach. One end of the abdominal muscle is cut while the uncut area allows permanent blood flow. The skin, fat and muscle are tunneled under the skin to the breast area, which may cause some bulging.

After the flap has been transferred, either by tunneling or by the free TRAM procedure, the tissue is molded to resemble the shape and size of the opposite breast instead of the typical round shape of an implant. The free tissue transfer allows the surgeon greater freedom to shape the new breast, while the pedicle TRAM procedure is limited by the connected muscle.

"The benefit of the free TRAM over a pedicle TRAM flap procedure is that the breast will have a better shape, especially for larger busted women," explained Topham. "The free TRAM eliminates the bulge created by the muscle tunneled to the breast are for the pedicle TRAM procedure. For some free TRAM cases, we may be able to remove only the skin and fat, leaving the abdominal muscle completely intact."

Fox Chase Cancer Center, one of the nation's first comprehensive cancer centers designated by the National Cancer Institute in 1974, conducts basic and clinical research; programs of prevention, detection and treatment of cancer; and community outreach. For more information about Fox Chase activities, visit the Center's web site at

Fox Chase Cancer Center, part of the Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence four consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach.  For more information, call 1-888-FOX CHASE or (1-888-369-2427).

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