Bipedicled TRAM Breast Reconstruction Workup

  • Author: Michael R Zenn, MD, FACS; Chief Editor: James Neal Long, MD, FACS   more...
 
Updated: Dec 6, 2011
 

Laboratory Studies

Consultation is required for the patient to understand the magnitude of the intended procedure. Discussion should include possible complications and necessary scars, and the patient should have the opportunity to view pictures of an average TRAM flap result. Some patients find it helpful to speak to a prior patient who was once in a similar situation. Answer all questions to give the patient realistic expectations. Preoperative laboratory examination is directed by the patient's medical condition. At minimum, perform the following:

  • CBC count
  • Electrolytes
  • Urinalysis
  • Chest radiograph
  • ECG
  • Type and screen
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Michael R Zenn, MD, FACS  Associate Professor, Vice Chief, Division of Plastic and Reconstructive Surgery, Program Director of Plastic Surgery Residency, Duke University Medical Center

Michael R Zenn, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Plastic Surgeons, American College of Surgeons, American Medical Association, American Society for Reconstructive Microsurgery, American Society of Plastic Surgeons, North Carolina Medical Society, Phi Beta Kappa, Plastic Surgery Research Council, Southeastern Society of Plastic and Reconstructive Surgeons, and World Society for Reconstructive Microsurgery

Disclosure: LifeCell Honoraria Speaking and teaching; Novadaq Consulting fee Consulting

Specialty Editor Board

Pankaj Tiwari, MD  Assistant Professor, Division of Plastic Surgery, Ohio State University College of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Saleh M Shenaq, MD†  Former Director and Founder, The International Brachial Plexus Institute; Former Chief, Section of Plastic Surgery, Methodist Hospital, Houston

Saleh M Shenaq, MD† is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Pediatrics, American Association for Hand Surgery, American Association for the Advancement of Science, American Association of Plastic Surgeons, American Burn Association, American College of Physician Executives, American College of Surgeons, American Congress of Rehabilitation Medicine, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Gene Therapy, American Society of Law, Medicine & Ethics, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Trauma Society, Association for Academic Surgery, International College of Surgeons, Lipoplasty Society of North America, Plastic Surgery Research Council, Society for Neuroscience, Society of Surgical Oncology, Southern Medical Association, Texas Medical Association, and Texas Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

James Neal Long, MD, FACS  Associate Professor of Plastic and Reconstructive Surgery, Division of Plastic Surgery, Children's Hospital and Kirklin Clinics, University of Alabama at Birmingham School of Medicine; Chief of Plastic, Reconstructive, Hand, and Microsurgery, Birmingham Veterans Affairs Medical Center

James Neal Long, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Society of Plastic Surgeons, Plastic Surgery Research Council, Sigma Xi, Southeastern Society of Plastic and Reconstructive Surgeons, and Southeastern Surgical Congress

Disclosure: Nothing to disclose.

References

  1. Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg. Feb 1982;69(2):216-25. [Medline].

  2. Laurent B, Rouif M, Giordano P, Mateu J. [Breast reconstruction with TRAM flap after selective embolization of the deep inferior epigastric artery (series of 69 patients).]. Ann Chir Plast Esthet. Oct 29 2011;[Medline].

  3. Momoh AO, Colakoglu S, Westvik TS, Curtis MS, Yueh JH, de Blacam C, et al. Analysis of Complications and Patient Satisfaction in Pedicled Transverse Rectus Abdominis Myocutaneous and Deep Inferior Epigastric Perforator Flap Breast Reconstruction. Ann Plast Surg. Jun 8 2011;[Medline].

  4. Bostwick J. Abdominal flap reconstruction. In: Plastic and Reconstructive Breast Surgery. 2nd ed. St Louis, Mo: Quality Medical Publishing Inc; 2000:981-1146.

  5. Dulin WA, Avila RA, Verheyden CN, et al. Evaluation of abdominal wall strength after TRAM flap surgery. Plast Reconstr Surg. May 2004;113(6):1662-5; discussion 1666-7. [Medline].

  6. Hartrampf CR Jr. The transverse abdominal island flap for breast reconstruction. A 7- year experience. Clin Plast Surg. Oct 1988;15(4):703-16. [Medline].

  7. Lejour M, Dome M. Abdominal wall function after rectus abdominis transfer. Plast Reconstr Surg. Jun 1991;87(6):1054-68. [Medline].

  8. Moon HK, Taylor GI. The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg. Nov 1988;82(5):815-32. [Medline].

  9. Ng RL, Youssef A, Kronowitz SJ, et al. Technical variations of the bipedicled TRAM flap in unilateral breast reconstruction: effects of conventional versus microsurgical techniques of pedicle transfer on complications rates. Plast Reconstr Surg. Aug 2004;114(2):374-84; discussion 385-8. [Medline].

  10. Shaw WW, Orringer JS, Ko CY, et al. The spontaneous return of sensibility in breasts reconstructed with autologous tissues. Plast Reconstr Surg. Feb 1997;99(2):394-9. [Medline].

  11. Shestak KC. Bipedicle TRAM flap reconstruction. In: Spear SL, ed. Surgery of the Breast: Principles and Art. 2nd ed. Philadelphia, Pa: Lippincott-Raven; 2006:719-31.

  12. Simon AM, Bouwense CL, McMillan S, et al. Comparison of unipedicled and bipedicled TRAM flap breast reconstructions: assessment of physical function and patient satisfaction. Plast Reconstr Surg. Jan 2004;113(1):136-40. [Medline].

  13. Zienowicz RJ, May JW Jr. Hernia prevention and aesthetic contouring of the abdomen following TRAM flap breast reconstruction by the use of polypropylene mesh. Plast Reconstr Surg. Nov 1995;96(6):1346-50. [Medline].

 
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Blood supply to bipedicle transverse rectus abdominus myocutaneous (TRAM) flap. Note the bilateral superior epigastric blood supply and the shaded area of the TRAM flap to be discarded.
Patient 1. This patient has a large breast to match and is not interested in a breast reduction. Note the ample lower abdominal tissues available for reconstruction.
Patient 1. Postoperative view at 1 year after all stages of reconstruction were complete. Bipedicle transfer allows reliable transfer of a large bulk of lower abdominal tissues to match the large opposite breast. Note the improved abdominal contour, a benefit of the transverse rectus abdominus myocutaneous procedure.
 
 
 
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