Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Advancements in Breast Reconstruction

This book chapter presents a case report and discussion on the use of the transverse rectus abdominis myocutaneous (TRAM) flap for breast reconstruction following revision radical mastectomy in a patient with recurrent left breast tumour. The case presentation describes the preoperative condition, diagnosis, and the need for revision surgery and breast reconstruction. The operative procedure involved revision radical mastectomy, left axillary clearance, and reconstruction using a contralateral pedicled TRAM flap.

The surgical technique included flap planning and marking, flap elevation, transfer to the defect site through a subcutaneous tunnel, and final inset to reconstruct the left mastectomy defect. The donor site in the lower abdomen was closed primarily. The postoperative period remained uneventful, and satisfactory results were observed during follow-up examinations.

The discussion section introduces the TRAM flap technique as a well-established surgical option for breast reconstruction. The surgical techniques are described, including patient evaluation and planning, flap design and marking, incision and flap elevation, flap transposition and shaping, and donor site closure. The advantages of the technique, such as natural tissue characteristics, adequate tissue volume, consistent blood supply, and simultaneous abdominal contouring, are highlighted. The limitations, including muscle sacrifice, donor site morbidity, and longer operative time and recovery, are also discussed.

The abstract emphasizes the significance of the TRAM flap technique in breast reconstruction, particularly in cases of mastectomy. It highlights the importance of careful patient evaluation, meticulous surgical planning, and consideration of the advantages and limitations of the TRAM flap procedure. By understanding the principles and techniques of the TRAM flap, surgeons can achieve satisfactory outcomes in breast reconstruction, providing patients with natural-looking results and potential abdominal contouring benefits