This is a 45-year-old woman who presented 7 years after having a right lumpectomy with radiation. She developed a recurrence in the right breast and was working with a general surgeon to perform bilateral mastectomy. She requested reconstruction. Because of the prior radiation, implant-based reconstruction options were limited. The patient did desire improvements in her abdominal appearance and was hoping to have her own tissues utilized to create breast mounds after mastectomy. She was provided options including microsurgical reconstruction with abdominal based flaps also known as DIEP flaps As well as pedicled TRAM flaps which do not involve microsurgical technique.
The patient chose bilateral TRAM flaps with pedicle technique. Her initial procedure went well and subsequent nipple reconstructions were performed and subsequent tattooing. The result is more even-appearing breasts, even slightly larger and an abdominoplasty appearance of her abdomen.
Bilateral TRAM flaps are not performed as frequently as they were in the 90s and early 2000s as microsurgical technique has expanded in our country- however, for the proper patient, they can provide an excellent option for reconstruction. They may require several additional procedures to improve results including nipple reconstruction and tattooing. Pedicle TRAM flaps do result in more abdominal wall morbidity and weakness compared to microsurgical technique although this patient did not have problems with this.