Tailoring of the new breast using the transverse abdominal island flap.

In the past 2 years we have moved from a period of amazement to an era of refinement in breast reconstruction using the transverse abdominal island flap (Fig. 9). It is essential that more effort be concentrated on improving the shaping of the new breast once the flap is brought safely to the chest. Important elements of this shaping include: Thorough preoperative planning. Use of the contralateral rectus pedicle. Discarding of skin from the scar to the inframammary line on the chest wall. Understanding of the tissue needed for each quadrant of the new breast. Proper orientation of the flap on the chest wall. Initial pivot suture around which the flap is shaped. Avoidance of excessive internal suturing. While we believe the preceding principles to be fundamental to the creation of the new breast using this flap, each surgeon must utilize his or her own creativity, insight, and training to maximize the tremendous advantage of versatility that this flap provides.