Abstract
The transverse rectus abdominis myocutaneous (TRAM) flap in all its modifications has become the prime choice for autologous breast reconstruction. Many refinements that increased the versatility and safety in recent years also led to significant improvements in the aesthetic outcome. Special emphasis has been put on minimizing the donor site morbidity by developing “muscle-sparing” techniques for the pedicle TRAM flap. Major modifications for the microvascular TRAM flap were the “micro” muscle island and the pure perforator (deep inferior epigastric perforator) flap. The internal mammary vessels have replaced the thoracodorsal arcade as the preferred anastomotic site. This article describes the technical details of some of these refinements, their indication, and the achievable results.
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