Unipedicled TRAM Breast Reconstruction Workup

  • Author: Michael R Zenn, MD, FACS; Chief Editor: James Neal Long, MD, FACS   more...
 
Updated: Feb 2, 2012
 

Laboratory Studies

  • Preoperative laboratory examination is directed by the patient's medical condition. At minimum, obtain CBC count, electrolytes, urinalysis, ECG, and blood type and screen.
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Imaging Studies

  • Chest radiographs
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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

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.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous editor Saleh Shenaq, MD, to the development and writing of this article.

References

  1. Spear SL, Ducic I, Low M, Cuoco F. The effect of radiation on pedicled TRAM flap breast reconstruction: outcomes and implications. Plast Reconstr Surg. Jan 2005;115(1):84-95. [Medline].

  2. Ascherman JA, Seruya M, Bartsich SA. Abdominal wall morbidity following unilateral and bilateral breast reconstruction with pedicled TRAM flaps: an outcomes analysis of 117 consecutive patients. Plast Reconstr Surg. Jan 2008;121(1):1-8. [Medline].

  3. Jensen JA. TRAM flap delay: new data addressing old questions. Plast Reconstr Surg. Jun 2009;123(6):1883-5. [Medline].

  4. Erdmann D, Sundin BM, Moquin KJ, et al. Delay in unipedicled TRAM flap reconstruction of the breast: a review of 76 consecutive cases. Plast Reconstr Surg. Sep 1 2002;110(3):762-7. [Medline].

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

  6. O'Shaughnessy KD, Mustoe TA. The surgical TRAM flap delay: reliability of zone III using a simplified technique under local anesthesia. Plast Reconstr Surg. Dec 2008;122(6):1627-30. [Medline].

  7. Zenn MR, Garofalo JA. Unilateral nipple reconstruction with nipple sharing: time for a second look. Plast Reconstr Surg. Jun 2009;123(6):1648-53. [Medline].

  8. 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].

  9. 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].

  10. Chun YS, Sinha I, Turko A, Lipsitz S, Pribaz JJ. Outcomes and patient satisfaction following breast reconstruction with bilateral pedicled TRAM flaps in 105 consecutive patients. Plast Reconstr Surg. Jan 2010;125(1):1-9. [Medline].

  11. 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].

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

  14. Rossetto LA, Abla LE, Vidal R, Garcia EB, Gonzalez RJ, Gebrim LH, et al. Factors associated with hernia and bulge formation at the donor site of the pedicled TRAM flap. Eur J Plast Surg. Aug 2010;33(4):203-208. [Medline]. [Full Text].

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

  16. 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].

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

  18. 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].

  19. Shestak KC. Technical tips for avoiding complications in TRAM flap breast reconstruction. In: Reoperative Plastic Surgery of the Breast. Philadelphia, Pa: Lippincott Williams and Williams; 2006:302-39.

  20. Zenn MR, May JW Jr. TRAM flap reconstruction: the single pedicle, whole muscle technique. In: Spear SL, ed. Surgery of the Breast: Principles and Art. Philadelphia, Pa: Lippincott-Raven Publishers; 2006:732-40.

  21. Tan BK, Joethy J, Ong YS, Ho GH, Pribaz JJ. Preferred Use of the Ipsilateral Pedicled TRAM Flap for Immediate Breast Reconstruction: An Illustrated Approach. Aesthetic Plast Surg. Jul 2 2011;[Medline].

 
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Blood supply to the unipedicled transverse rectus abdominis myocutaneous (TRAM) flap. Note the superior epigastric supply and the shaded area of the TRAM flap to be discarded.
Patient 1: The small-breasted patient did not want contralateral augmentation, and it would be difficult to match her breasts with an implant alone.
Patient 1: Postoperative view after unipedicled transverse rectus abdominis myocutaneous flap reconstruction. This small breast with ptosis would be impossible to achieve with an implant.
Patient 2: A full C cup breast and an ample abdomen for an unipedicled transverse rectus abdominis myocutaneous reconstruction
Patient 2: Postoperatively after unipedicled transverse rectus abdominis myocutaneous and nipple reconstruction. Note the improvement in the patient's abdominal appearance, a benefit of this type of reconstruction. She has been encouraged to return for re-application of the removed portion of her tattoo.
Patient 3: The patient's right lateral scar during initial biopsy precludes a true skin-sparing approach. With ample abdominal tissue, she is an excellent candidate for unipedicled transverse rectus abdominis myocutaneous reconstruction.
Patient 3: Postoperative view after unipedicled transverse rectus abdominis myocutaneous flap reconstruction. Note the abdominal skin replacing the removed skin to maintain breast shape. The patient does not desire nipple reconstruction.
 
 
 
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