Study Objective Abdominal wall anatomy can be altered after transverse rectus abdominis myocutaneous flap (TRAM) procedure in patient with breast cancer and the umbilicus may be distorted. For this reasons, laparoscopic gynecologic surgery is difficult procedure including proper port placement, the knowledge of the residual blood supply to the abdominal wall and umbilicus. We present our experience performing single port access total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (SPA-TLH BSO) on a woman after TRAM surgery. Design N/A Setting N/A Patients or Participants N/A Interventions 53 years old woman who were diagnosed with breast cancer got left modified radical mastectomy followed by the breast mound reconstruction with contralateral pedicled TRAM flap three years ago. she took two cycles of chemotherapy after surgery. Since then, she has been taking tamoxifen and referred to Gynecologic oncology department for growing uterine myoma. 8 × 7 cm sized uterine myoma on transvaginal sonography was observed. The patient was recommended with hysterectomy and bilateral salpingo-oophorectomy. Transumbilical SPA TLH and BSO were performed after confirming the pathway of the vessel of pedicle by Abdominal-pelvic CT. Measurements and Main Results After making of altered anatomy of abdominal muscle flap, self designed single port system was made using the wound retractor and a surgical glove on umbilicus. We did not make additional port placement to avoid damage of abdominal wall with previous TRAM procedure. patient underwent successful SPA TLH and BSO transumbilical incision for single port placement. There was no complication during operation. Conclusion Single port access laparoscopic surgery is feasible in women after TRAM reconstruction. Knowledge of anatomic and physiologic variations related to the TRAM procedure is necessary in planning a safe operation.