Free TRAM Breast Reconstruction Workup

  • Author: Michael R Zenn, MD, FACS; Chief Editor: James Neal Long, MD, FACS   more...
 
Updated: Feb 1, 2012
 

Laboratory Studies

Preoperative laboratory examination is directed by the patient's medical condition. At minimum, obtain the following:

  • CBC count
  • Electrolytes
  • Urinalysis
  • Blood type and screen
Next

Imaging Studies

  • Chest radiograph(s)
  • Contralateral mammogram within 6 months
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Other Tests

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

  2. Hudson DA. The surgically delayed unipedicled TRAM flap for breast reconstruction. Ann Plast Surg. Mar 1996;36(3):238-42; discussion 242-5. [Medline].

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

  4. Schusterman MA. The free TRAM flap. Clin Plast Surg. Apr 1998;25(2):191-5. [Medline].

  5. Selber JC, Fosnot J, Nelson J, Goldstein J, Bergey M, Sonnad S, et al. A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: Part II. Bilateral reconstruction. Plast Reconstr Surg. Nov 2010;126(5):1438-53. [Medline].

  6. Allen RJ. DIEP versus TRAM for breast reconstruction. Plast Reconstr Surg. Jun 2003;111(7):2478. [Medline].

  7. Nahabedian MY, Momen B, Galdino G, Manson PN. Breast Reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg. Aug 2002;110(2):466-75; discussion 476-7. [Medline].

  8. Nahabedian MY, Tsangaris T, Momen B. Breast reconstruction with the DIEP flap or the muscle-sparing (MS-2) free TRAM flap: is there a difference?. Plast Reconstr Surg. Feb 2005;115(2):436-44; discussion 445-6. [Medline].

  9. Roth FS, Troy JS, Schusterman MA. Transverse dual-perforator fascia-sparing free TRAM flap: technique description. Plast Reconstr Surg. Nov 2011;128(5):1039-42. [Medline].

  10. 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].

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

  12. Alderman AK, Wilkins EG. Radiation therapy in postmastectomy TRAM reconstruction. Plast Reconstr Surg. Mar 2002;109(3):1199-200. [Medline].

  13. Bostwick J. Microsurgical techniques. In: Plastic and Reconstructive Breast Surgery. 2nd ed. St. Louis: Quality Medical Publishing Inc; 2000:1147-1252.

  14. Chevray PM. Breast reconstruction with superficial inferior epigastric artery flaps: a prospective comparison with TRAM and DIEP flaps. Plast Reconstr Surg. Oct 2004;114(5):1077-83; discussion 1084-5. [Medline].

  15. Grotting JC, Oslin BD. Free TRAM flap breast reconstruction. In: Spear SL. Surgery of the Breast: Principles and Art. Philadelphia, Pa: Lippincott-Raven Publishers; 1998:555-563.

  16. Lindsey JT. Integrating the DIEP and muscle-sparing (MS-2) free TRAM techniques optimizes surgical outcomes: presentation of an algorithm for microsurgical breast reconstruction based on perforator anatomy. Plast Reconstr Surg. Jan 2007;119(1):18-27. [Medline].

  17. 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].

  18. Slavin SA, Goldwyn RM. The midabdominal rectus abdominis myocutaneous flap: review of 236 flaps. Plast Reconstr Surg. Feb 1988;81(2):189-99. [Medline].

  19. Thoma A, Veltri K, Khuthaila D, et al. Comparison of the deep inferior epigastric perforator flap and free transverse rectus abdominis myocutaneous flap in postmastectomy reconstruction: a cost-effectiveness analysis. Plast Reconstr Surg. May 2004;113(6):1650-61. [Medline].

  20. Zenn MR. Control of breast contour by the use of Z-plasty in the irradiated breast reconstruction. Plast Reconstr Surg. Jul 2003;112(1):210-4. [Medline].

 
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Diagram of the blood supply to the free transverse rectus abdominis myocutaneous (TRAM) flap. Note that the deep inferior epigastric vessels supply the flap, the primary blood supply to the lower abdomen. The shaded areas of the flap are discarded.
Patient 1. This patient has small breasts and has a small amount of abdominal tissue available. This is the perfect indication for a free transverse rectus abdominis myocutaneous (TRAM) flap to maximize the amount of tissue available for reconstruction.
Patient 1. Postoperative view. Note the natural ptosis of the reconstruction and the distinct inframammary fold, not distorted by a muscle pedicle from the abdomen. The patient does not desire nipple-areolar reconstruction.
Patient 2. This patient has a large opposite breast to match and does not desire a breast reduction. A free transverse rectus abdominis myocutaneous (TRAM) flap allows a large block of tissue to be transferred, matching the opposite breast.
Patient 2. Postoperative view. The breast envelope has been filled with the free transverse rectus abdominis myocutaneous (TRAM) flap. Note the abdominal improvement, an added benefit of the TRAM procedure. The patient still requires nipple-areolar reconstruction.
Patient 3. Preoperative markings. The patient has a large opposite breast and does not desire breast reduction. Note the large amount of skin that will be removed. A free transverse rectus abdominis myocutaneous (TRAM) allows a large reconstruction to match the opposite side.
Patient 3. Postoperative view. There is a good volume match, and the resected breast skin has been replaced with abdominal skin.
Patient 3. Postoperative view. In this view, note the natural droop of the reconstruction, unobtainable with breast implants. All of the patient's scars are below her tan lines.
 
 
 
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