Breast reconstruction using the transverse rectus abdominis musculocutaneous (TRAM) free flap

ABSTRACT

Breast reconstruction is achieved through surgical procedures following mastectomy after breast cancer or trauma using implants or autologous tissue to restore the breast morphology. Reconstruction can physically and emotionally restore a patient's self confidence after the loss of a breast. The method of breast reconstruction is determined by several factors, such as the patient's general medical condition, the extent of the mastectomy, and donor site suitability when opting for autologous flap transplantation. Generally, we can classify breast reconstruction procedures into two broad categories breast implantation after tissue expansion of the skin of the chest, and flaps using autologous tissue. Of the breast reconstruction methods using autologous tissue, the transverse rectus abdominis musculocutaneous free flap is advantageous over the the transverse rectus abdominis musculocutaneous (TRAM) pedicled flap in that it is easy to obtain the desired shape of the breast, the inframammary fold is maintained, and there is decreased donor site morbidity because the rectus abdominis muscle can be utilized sparingly. Moreover, the TRAM free flap can have an abdominoplasty effect in women who have excessive abdominal fat. However, the procedure is time consuming because microanastomosis of the pedicle and recipient vessel is necessary after flap elevation. Although there are several issues, such as the high cost of surgery, which should be resolved, breast reconstruction can provide support to many women who are emotionally and physically distressed due to breast cancer.