The TRAM flap is a tissue transfer that does not use implants. It is a 6 hour operation. The implants require either a "back" flap or latissimus dorsi muscle flap and an implant, or a tissue expander that is slowly inflated over time. Both of those operations require less time and have fewer complications. Each patient has special requirements and so I cannot say which will be best for you. You will need to seek out advice from a board certified plastic surgeon to get your best answer. I hope this helps you, respectfully,
arch s miller ms md facs