Free Flap Breast Research Articles

Secondary shaping of the free TRAM: an inferior pedicle reduction mammaplasty

Secondary shaping of the transverse rectus abdominis myocutaneous (TRAM) flap is a routine treatment, and includes liposuction, skin excision, inframammary fold replacement, dermal fat grafts or lipofilling. Major flap revision may include an augmentation procedure with implants or expanders. We present an inferior pedicle breast reduction in a woman who underwent breast reconstruction using a free TRAM flap. To our knowledge, there are no reports about reduction mammaplasty or mastopexy in Free TRAM flap breast reconstruction. Reduction mammaplasty should be regarded as a valuable option in free TRAM or deep inferior epigastric perforator secondary reshaping.

Sensibility Following Innervated Free TRAM Flap Breast Reconstruction

Sensibility Following Innervated Free TRAM Flap Breast Reconstruction

Free DIEAP and SGAP Flap Breast Reconstruction After Abdominal/Gluteal Liposuction

Free DIEAP and SGAP Flap Breast Reconstruction After Abdominal/Gluteal Liposuction

Impact of Recipient Vessels in Free TRAM Flap Breast Reconstruction: An Analysis of 1483 Consecutive Cases

Impact of Recipient Vessels in Free TRAM Flap Breast Reconstruction: An Analysis of 1483 Consecutive Cases

84: Randomized, Controlled, Double-Blind Evaluation of Local Anesthetic Infusion Pumps for Donor Site Pain Management Following Free TRAM Flap Breast Reconstruction

84: Randomized, Controlled, Double-Blind Evaluation of Local Anesthetic Infusion Pumps for Donor Site Pain Management Following Free TRAM Flap Breast Reconstruction

3–57 Comparison of Donor-Site Complications and Functional Outcomes in Free Muscle-Sparing TRAM Flap and Free DIEP Flap Breast Reconstruction

3–57 Comparison of Donor-Site Complications and Functional Outcomes in Free Muscle-Sparing TRAM Flap and Free DIEP Flap Breast Reconstruction

Efficacy of Preoperative Autologous Blood Donation in Free TRAM Flap Breast Reconstruction

Efficacy of Preoperative Autologous Blood Donation in Free TRAM Flap Breast Reconstruction

Comparison of Cost for DIEP and Free TRAM Flap Breast Reconstructions

Comparison of Cost for DIEP and Free TRAM Flap Breast Reconstructions

Free tram flap breast reconstruction after skin-sparing mastectomy

Skin-sparing mastectomy offers many advantages to the patient who is undergoing mastectomy with immediate breast reconstruction. Breast skin that is not involved with tumor is preserved for use in the reconstruction, not only providing coverage but also helping to correctly shape and position the breast. Visible scarring and skin replacement are reduced, improving the cosmetic outcome. Subcutaneous fat preservation also reduces the amount of tissue required for adequate breast mound reconstruction, a factor that can be important in thin patients who are undergoing bilateral reconstruction with TRAM flaps. The free TRAM flap, with splitting and partial preservation of the muscle, is my preferred technique of reconstruction for most patients because it combines well-vascularized autologous tissue with acceptable (and minimal) donor site morbidity. For patients who do not need more than 65% of the TRAM flap to reconstruct an adequate breast mound, however, the DIEP flap can be a good alternative.

Recipient vessels in free-flap breast reconstruction: a study of the internal mammary and thoracodorsal vessels.

The internal mammary vessels as recipient site for free flaps in breast reconstruction were investigated in this paper because of their ideal location for breast reconstruction. Comparisons were made with the thoracodorsal vessels in terms of external vessel diameter, vessel size discrepancy, flap loss and reexploration rates, and ease of flap placement. Eighty-one patients underwent 110 breast free-flap reconstructions (92 TRAM flaps and 18 superior gluteal flaps) between 1988 and 1994. Vessel size measurements were available on 75 flaps. The internal mammary artery diameter (2.36 +/- 0.50 mm, n = 51) was significantly larger than the thoracodorsal artery diameter (1.79 +/- 0.34 mm, n = 23; p < 0.001). There was no significant difference between the diameters of the internal mammary vein 2.6 +/- 0.58 mm, n = 52) and thoracodorsal vein (2.51 +/- 0.50 mm, n = 23; p = 0.93). The right internal mammary artery (2.52 +/- 0.51 mm) was significantly larger than the left internal mammary artery (2.30 +/- 0.55 mm; p = 0.046). The right internal mammary vein (2.89 +/- 0.56 mm) also was significantly larger than the left internal mammary vein (2.31 +/- 0.48 mm; p = 0.002). In terms of vessel size discrepancy, the internal mammary recipient artery tended to be greater in size than the TRAM flap donor artery (p = 0.003), while the thoracodorsal recipient artery tended to be smaller than the TRAM flap donor artery (p = 0.002). Flap failures and flap reexplorations occurred in the group using the thoracodorsal vessels but not in the internal mammary group. Correct flap placement using the internal mammary recipient site was achieved more easily for both unilateral and bilateral reconstructions because of the avoidance of lateral fullness and medial deficiency problems. The internal mammary recipient site is an important and at times superior alternative to the axillary recipient site because of its larger artery, especially when the axilla is scarred. For smaller free flaps such as a hemi-TRAM flap, as in bilateral TRAM flap reconstructions, the internal mammary site is invaluable because this recipient site allows exact placement of a smaller flap in the breast area.

Free TRAM flap breast reconstruction

Free TRAM flap breast reconstruction has been developed in an attempt to reduce abdominal wall morbidity and increase flap vascularity. The potential for total flap loss limits the procedure to those experienced in microsurgery. The indications and operative technique are described.