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J Korean Med Assoc > Volume 54(1); 2011 > Article
Eom: Breast reconstruction using pedicled transverse rectus abdominis musculocutaneous (TRAM) flap

Abstract

The demand for the breast reconstruction continues to grow following the acute increase in the incidence of breast cancer in Korea. The pedicled transverse rectus abdominis musculocutaneous (TRAM) flap is one of the most commonly used methods among the autologous breast reconstruction options. A pedicled TRAM flap consists of the lower abdominal skin, subcutaneous fat tissue, and one of the rectus abdominis muscles. The blood flow to the flap is supplied through the muscle perforators, which should be strictly selected and preserved. This flap can provide sufficient healthy tissue, which can create the most ideal breast shape. Although the free flap has largely replaced the pedicled TRAM flap, the latter has also evolved with increased understanding of anatomy and physiology. Furthermore, if refined techniques are applied, complications can be minimized and comparable outcomes can be achieved. Besides all the advantages of autologous tissue breast reconstruction, the most distinct feature of the pedicled TRAM flap over the free flap is simplicity of flap elevation and elimination of the microsurgical crisis. The pedicled TRAM flap is still a competitive procedure, yielding consistent results with acceptable complication rates for most patients and should be considered as a primary option for breast reconstruction.

References

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Figure 1
Transverse rectus abdominis musculocutaneous (TRAM) flap is lifted from the abdominal wall after completion of elevation process. TRAM flap consists of the lower abdominal skin and fat tissue which will contribute to shaping of breast and rectus abdominis muscle which will play the role of bridge of blood supply.
jkma-54-12-g001-l.jpg
Figure 2
Eighth intercostal nerve is identified just before the entrance to the rectus muscle. Ligation of the nerve is helpful to reduce rectus muscle mass.
jkma-54-12-g002-l.jpg
Figure 3
Meticulous closure of the anterior rectus sheath is crucial to prevent abdominal bulge or hernia. Plication of the contralateral side sheath can balance the tension across the whole abdomen and smooth the contour of the abdomen.
jkma-54-12-g003-l.jpg
Figure 4
Preoperative and postoperative photo of 32 year-old women who underwent nipple-sparing mastectomy and immediate breast reconstruction. Her left breast was reconstructed with pedicled transverse rectus abdominis musculocutaneous (TRAM) flap and her right breast was lifted with periareolar mastopexy. TRAM flap is the best resource to create natural and ptotic breast.
jkma-54-12-g004-l.jpg
Figure 5
Thirty-five year-old lady underwent skin-sparing mastectomy and immediate reconstruction with transverse rectus abdominis musculocutaneous flap. Nipple reconstruction was done in second stage and areola tattoo is planned.
jkma-54-12-g005-l.jpg
Figure 6
Delayed reconstruction was performed with transverse rectus abdominis musculocutaneous (TRAM) flap for 54 year-old lady who lost her right breast after modified radical mastectomy. Her left breast was reduced for symmetrization. TRAM flap can provide sufficient skin and soft tissue for delayed recosntruciton.
jkma-54-12-g006-l.jpg


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