When is a unipedicled TRAM breast reconstruction procedure indicated?

Updated: Feb 14, 2019
  • Author: Michael R Zenn, MD, MBA, FACS; Chief Editor: James Neal Long, MD, FACS  more...
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Answer

Transverse rectus abdominis myocutaneous (TRAM) flap reconstruction may be considered in any patient who is undergoing mastectomy as either an immediate procedure (at the time of mastectomy) or as a delayed procedure (sometime after mastectomy). If chest wall radiation has been or will be part of the patient's therapy, reconstruction is delayed. [2] The patient must be psychologically motivated and have adequate tissues in the abdominal area to be considered for a TRAM flap. Although implant reconstruction and tissue reconstruction may be considered for any patient, some relative indications favor the TRAM flap procedure.

  • Radical mastectomy defect with large tissue requirement

  • History of radiation to the chest wall

  • Large opposite breast (difficult to match with an implant)

  • Small opposite breast (difficult to match with an implant)

  • Previous failure of implant reconstruction

  • Excess lower abdominal tissue and patient desires abdominoplasty


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