The transverse rectus abdominis myocutaneous (TRAM) flap, both free and pedicle, has been used by plastic surgeons for more than 20 years for breast reconstruction. During this procedure, abdominal tissue - including part of, or all of, the rectus abdominis muscle - is transferred to the chest. During a pedicle TRAM, the tissue remains attached to the body and is tunneled under the skin to the chest. During a free TRAM, the tissue is removed from the body and then reattached at the chest. In both instances, a large amount of abdominal muscle is removed, leading to core muscle weakness, hernias, and bulges. Learn more about TRAM flaps.