Abstract
Multiple techniques exist for transfer of lower abdominal tissue for breast reconstruction. Unlike the pedicled TRAM flap, free tissue transfer minimizes disruption of the abdominal donor site. However, the decision to proceed with a free TRAM, DIEP, or an SIEA flap is not arbitrary. The purpose of this report was to outline a strategy for flap selection, particularly in cases of previous abdominal surgery that may impact upon lower abdominal vascularity. A microsurgeon's first 3-year experience with free flap breast surgery was reviewed, noting previous abdominal scars, flap selection, including dominant perforator location in the case of the DIEP, and complications including fat necrosis.
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