Unipedicled Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Breast Reconstruction

Breast reconstruction with a transverse rectus abdominis myocutaneous flap (TRAM) or muscle-sparing (ms-TRAM) is a specific type of breast reconstruction that allows women to have delayed or immediate breast restoration. Because the tissue is part of the patient's body, this benefits the patient. First, a foreign body is not introduced, so common complications associated with implant breast reconstruction, such as inflammatory reaction or capsular contracture, are avoided. Second, the abdominal donor site scar can be hidden under most clothing styles. Assessing the patient is the first step in deciding if they are a good candidate for this procedure. The clinician should focus on the breast defect and determine the necessary volume for correction. For immediate reconstruction of the breast, both oncologic and reconstructive surgeons can operate simultaneously and communicate about the incisions and mastectomy defect. If the clinician and patient decide on a delayed repair, a TRAM flap can provide additional skin and fatty tissue for breast volume and closure. An alternative to a TRAM is an ms-TRAM, which ultimately preserves most of the underlying muscle, potentially offering added benefits for patients by limiting the weakening of core muscles. An alternative to these procedures is the deep inferior epigastric perforator flap (DIEP), which consists only of skin, fat, and blood vessels, leaving the rectus abdominis musculature completely intact. However, it requires reattachment of blood vessels under a microscope. The latissimus dorsi myocutaneous flap is a good alternative option to both of these surgeries if patients have had extensive abdominal surgery or do not have adequate perforator vessels. A TRAM flap is a better option for patients with larger breasts or significant ptosis. A very important factor for aesthetic success is the match between the tissue volume of the TRAM flap and the other breast. The abdominal pannus is used to reconstruct the breast. Therefore, a thicker abdominal pannus for a smaller breast reconstruction often requires a secondary revision for symmetry, while a thinner patient with larger breasts would not be an ideal candidate. They may need a breast implant to supplement the paucity of tissue from the TRAM flap or reduce the opposite breast's size. The primary advantage for the patient is the similarity to a natural breast. This includes the softness and the appearance of the tissue on the chest. Based on the results from a nonrandomized control study, data show that at both 1 and 2 years postoperatively, patients who underwent TRAM flaps, both free and pedicled, DIEP, or superficial inferior epigastric artery flaps experienced similar patient satisfaction with their breasts across the groups. In a world where various flaps exist and patients have options, the TRAM flap remains viable for carefully selected patients at institutions where microsurgery is unavailable.