When is TRAM breast reconstruction indicated?

Updated: Jul 28, 2021
  • Author: Michael R Zenn, MD, MBA, FACS; Chief Editor: James Neal Long, MD, FACS  more...
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Consider bipedicle TRAM flap reconstruction in a patient undergoing bilateral mastectomy or in one who requires a large amount of tissue for a unilateral reconstruction and is not a candidate for a free TRAM flap. [4] The procedure may be performed either as an immediate procedure (at the time of mastectomy) or as a delayed procedure (sometime after mastectomy). The patient must be psychologically motivated and have adequate tissues in the abdominal area to be considered a candidate. The patient's lifestyle must allow for a diminution of truncal flexion strength. Most patients engaged in housework and ordinary athletic activities such as aerobics, tennis, golf, jogging, or walking report no limitation of postoperative activities. Some women cannot do sit-ups postoperatively.

Although implant reconstruction and tissue reconstruction may be considered for any patient, some relative indications favor the bipedicle TRAM flap procedure.

  • Radical mastectomy defect with large tissue requirement

  • History of radiation to the chest wall

  • Very large opposite breast (hard to match with an implant)

  • Failure of previous implant reconstruction

  • Excess lower abdominal tissue (patient desires abdominoplasty)

  • Previous lower midline incision and need for entire lower abdominal flap for reconstruction

  • No recipient vessels for a free flap reconstruction because of previous chest or axillary surgery or severe scarring from radiation therapy

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