The transverse rectus abdominis musculocutaneous free flap: a reliable alternative for delayed autologous tissue breast reconstruction.

The use of the pedicled transverse rectus abdominis musculocutaneous (TRAM) flap has been established world-wide for breast reconstruction. Until now, application of a TRAM free flap, however, has only taken place in special circumstances. The advantages of a TRAM free flap (such as better and more vigorous perfusion than with a pedicled TRAM flap and greater freedom in reconstruction, as well as a lower incidence of weakening within the abdominal wall) are so conclusive that it has become our preferred procedure for breast reconstruction. Twenty-five patients have successfully undergone this procedure at our division. In 6 patients, the arterial or venous microanastomosis, or both, required revision without experiencing, however, total flap loss. Partial flap loss occurred in only 1 patient. All patients (including those having undergone revision) were satisfied with their reconstructed breast form. This satisfaction can be directly attributed to the fact that with this procedure, a desired breast form and volume can almost always be achieved.