Workup
Laboratory Studies
Preoperative laboratory examination is directed by the patient's medical condition. At minimum, obtain the following:
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CBC count
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Electrolytes
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Urinalysis
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Blood type and screen
Next:
Imaging Studies
See the list below:
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Chest radiograph(s)
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Contralateral mammogram within 6 months
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Media Gallery
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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.
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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.
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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.
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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.
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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.
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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.
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Patient 3. Postoperative view. There is a good volume match, and the resected breast skin has been replaced with abdominal skin.
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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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