ABSTRACT
The transverse rectus abdominis musculocutaneous (TRAM) ap had its introduction as a technique for breast reconstruction more than 20 years ago. Initially described by Holmstrom1 as a free ap, it was later popularised by Hartrampf2 as a pedicled ap, who independently conceived of its use as an abdominal island ap for breast reconstruction. Drawing on the work of Esser, Hartrampf theorised that the lower abdominal skin and fat could be transferred to the chest to create a breast mound based on circulation provided from the rectus abdominis muscle.
