Traditional breast conservative therapy (BCT) is lumpectomy, sentinel lymph node biopsy and   possible axillary dissection, and radiation therapy. BCT is, as known and considered all over the  world, is oncologically equivalent to mastectomy with regard to overall long-term survival rates.  BCT is the recommended treatment of choice for women with early stages breast cancer. The main
philosophy of BCT is optimizing cosmetic goals and minimizing the psychological morbidity  of a mastectomy while ensuring low rates of local recurrence. Achieving an oncologically safe  resection is maintained by tumor margin clearance. Ensuring an oncologic clearance with  increasing tumor size requires extensive breast parenchyma resection. And this results in large
volume resection and this requires volume replacement techniques. Depending on the amount of  breast volume resected, an autologous tissue transfer may be required to achieve requirement of  breast restoration. Latissimusdorsi flap and TRAM flap are two autologous tissues mostly used  to fulfill this restoration. This chapter focuses on the TRAM flap, one of the most commonly used autologous tissue in volume replacement reconstruction of the mastectomy defect.