This reconstructive option is similar to the TRAM flap procedure however it uses muscle, skin and underlying fatty tissue from the upper back to reconstruct the breast. This is a pedicle flap that is tunneled under the armpit region and used to reconstruct the breast mound. Most patients need a tissue expander and implant in conjunction with the flap to maintain the volume of the breast mound. This technique adds more of the patient's own tissue giving a more natural appearance to the breast.