How is abdominal closure performed in TRAM breast reconstruction?

Updated: Jul 28, 2021
  • Author: Michael R Zenn, MD, MBA, FACS; Chief Editor: James Neal Long, MD, FACS  more...
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Answer

Abdominal closure begins with closure of the fascia, performed primarily or with synthetic mesh. Since a large amount of fascia is harvested with both pedicles, the mesh is more likely to be needed than with the single pedicle technique. Closure primarily may be technically possible, although it may result in an excessively narrowed waist. Acellular dermal matrices (ADMs) can be used instead of synthetic meshes. [6, 7, 8] The patient's anatomy and preference of the surgeon dictate choice of closure.

Additional liposuction and skin tailoring may be necessary to achieve optimal aesthetic result.

Relocation of the umbilicus usually is necessary and appears as a new umbilicus in a similar position as preoperatively. Risk of necrosis of the umbilicus is real (10-20%) in a bipedicle case, as these muscles supply blood to the umbilicus.


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