Hernias and bulges that result from TRAM surgery are difficult problems to manage.  Multiple open and laparoscopic techniques are available.  An example of literature supporting laparoscopic repairs of these defects is Shaw et al. Annals of Plastic Surgery, Vol 56 (4), April 2006 DOI: 10.1097/01.sap.0000200281.24169. Laparoscopic repair often necessitates placement of a large piece of mesh in the peritoneal cavity in direct contact with the intestines.  This can result in mesh erosion into the intestines.  Additionally, the intraabdominal placement of the mesh creates a space for fluid to accumulate between the skin and mesh (seroma).  

There are also open repair options in the literature, including:

a. modification of the Ramirez technique with lateral implantation of mesh to offer support to the thinned abdominal wall (Kaemmer et al. J Med Case Reports 2008, 2:108 doi:10.1186/1752-1947-2-108)

b. underlay, onlay and intra-peritoneal mesh placement to support abdominal wall musculature (Ximena et al. Aesth Surg J 2014, Vol 34(2) 264–271, 2013 DOI: 10.1177/1090820X13517707)

c. Posterior component separation with transversus abdominus release (Espinosa-de-los-Monteros et al. Plast Reconstr Surg Glob Open 2016;4:e1014; doi: 10.1097/ GOX.0000000000001014; Published online 21 September 2016)

These operations require larger incisions and a more sophisticated understanding of complex anatomy.  Such operations usually are undertaken by specialists at tertiary facilities.