Autologous secondary breast augmentation with pedicled transverse rectus abdominis musculocutaneous flaps.

Bilateral secondary autologous breast augmentation with de-epithelialized, pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps was performed on four patients with severe capsular contracture or implant rupture after breast augmentation. Results are satisfactory: The patients are pleased and have no limitation of their normal activities. Two patients underwent secondary liposuction to refine the abdominal contour. In one patient mammographic calcifications developed secondary to fat necrosis in one flap, which resolved spontaneously in 4 months. Rigorous patient selection, a highly motivated thoroughly informed patient, and substantial prior surgical experience with TRAM flaps are mandatory. Total capsulectomy as well as tunneling and positioning of the TRAM flap are performed through the existing inframammary scar. Shaping the breast is easier and faster than in postmastectomy patients. These patients have high aesthetic expectations; they must be gratified with the abdominoplasty aspect of the procedure. Because the flaps are buried, the surgeon must feel certain of their vigorous circulation. Only 200 to 300 gm are needed to augment each breast; therefore, only the best perfused periumbilical tissue is used. The TRAM flap, although a major procedure with significant risks, is the first effective technique of autologous breast augmentation and may have wider application.