When is stage I TRAM breast reconstruction performed?

Updated: Jul 28, 2021
  • Author: Michael R Zenn, MD, MBA, FACS; Chief Editor: James Neal Long, MD, FACS  more...
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More than one procedure is required for a successful TRAM flap breast reconstruction.

Stage I: TRAM flap

Perform TRAM flap at mastectomy or afterward. If radiation therapy has been or will be in the therapeutic plan, reconstruction should be delayed until adjuvant therapy has been completed. Belly tissues are used to create the breast mound, and this stage may include a procedure on the opposite breast for best symmetry. Operation may take from 4-8 hours, and 90% of reconstructive work is performed during this procedure. In a bipedicle reconstruction, it is not unusual to have a large epigastric bulge from the bulk of 2 muscle pedicles in the tunnel to the chest. The bulge diminishes as muscles atrophy, but it may require revision if it persists 3-4 months postsurgery.

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