Which is the most likely complication after TRAM flap breast reconstruction using abdominal tissue?

• A. Restricted trunk mobility due to shortened abdominal tissue
• B. Necrosis at the donor site due to inadequate blood supply
• C. Reduced shoulder mobility due to the muscle flap attachment
• D. Low back pain due to weakened abdominal support

Answer: (D)

Harvesting tissue from the lower abdomen for a TRAM flap reduces the integrity of the abdominal wall. The abdominal muscles, especially the rectus abdominis, contribute significantly to core stability and to generating intra-abdominal pressure that supports the spine during movement. When this support is weakened, the lower back bears more of the load, leading to low back pain that is a common donor-site consequence. While other issues like scar complications or donor-site ischemia can occur, the most likely and impactful symptom seen is pain in the low back due to diminished abdominal support.