Options for breast reconstruction after oncologic treatment include the use of prosthetic materials, autologous tissues, as well as a combination of both. Worldwide, autologous breast reconstruction remains the gold standard, and Transverse Rectus Abdominis Muscle flap (TRAM flap), one of the most frequent choices. The present study determines the frequency of complications after breast reconstruction with pedicled TRAM flap at the Plastic and Reconstructive Department of the Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos in Mexico City (México). A period of 7 years was reviewed. In addition, risk factors that influenced the occurrence of such complications were analyzed. We designed an observational, descriptive and retrospective study that included 71 patients. Overall, 59.15% patients presented at least one complication. Most of these were considered minor (54.9%) and only 3 patients had a major complication (4.2%). The most common donor site complication was abdominal hernia (9.86%). The most frequent flap complication was partial fat necrosis (23.94%). The only 2 systemic complications were atelectasis and pulmonary embolism, with 1 case each. Bivariate analysis showed that smoking elevated 40% the risk for a flap complication (p=0.041). Patients with radiation therapy had a 30% increase in total complications (p=0.021). Thirty-two of the patients that received chemotherapy presented with fat necrosis while only 10% of the patients that did not receive chemotherapy had that problem (p=0.047). The use of pedicled TRAM flap remains so far the gold standard in breast reconstruction in our practice and as a major procedure, some complications may be expected, mostly minor. The results in our hospital are consistent with reports in the international literature.