When is stage II 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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Approximately 3-4 months after the TRAM flap procedure, tissues have settled enough and scar tissue has relaxed enough to perform small revisions and nipple reconstruction. Often this is performed in an office setting. Radiation and chemotherapy should be completed and a 4-6 week period should pass prior to further surgery. If some loss of transferred tissues has occurred, resulting in fat necrosis, remove these firm areas and reshape the mound to allow soft breast reconstruction. This may be observed more easily over time for evidence of cancer recurrence.

If revision to the breast mound is major, delay nipple reconstruction another 3-4 months for accurate position of the nipple reconstruction. Perform nipple reconstruction as a local tissue rearrangement or as a graft from the opposite nipple. Anatomy of the patient and preference of the surgeon dictate the choice.

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