Patients who have moderate excess abdominal tissue are candidates for breast reconstruction using the pedicle TRAM flap or the microsurgical techniques. The advantage of these flaps is that they replace soft, living tissue removed at the time of mastectomy with similar tissue from the abdomen. In the pedicle TRAM flap procedure, the lower abdominal fat and skin is harvested with one of the rectus abdominis muscles, which is transferred to the chest in a surgically created tunnel that connects the chest and abdomen. The muscle contains the blood vessels that supply the fat and skin, and is left attached to its origin from the lower ribs. The advantage of the pedicle TRAM flap is that it is safe, reliable, and shorter than the microsurgical procedures. The disadvantage is the higher risk of long-term abdominal problems, and a slightly higher risk of fat necrosis.