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    A TRAM flap design refinement for use in delayed breast reconstruction.

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    Authors
    Patel, A J K
    Kulkarni, M
    O'Broin, E S
    Affiliation
    Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital (Cambridge University Hospitals NHS Trust), Cambridge, UK. aj.patel@virgin.net
    Issue Date
    2009-09
    MeSH
    Abdominal Muscles
    Breast
    Esthetics
    Female
    Humans
    Mammaplasty
    Mastectomy
    Surgical Flaps
    Time Factors
    Wound Healing
    
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    Citation
    A TRAM flap design refinement for use in delayed breast reconstruction. 2009, 62 (9):1135-9 J Plast Reconstr Aesthet Surg
    Journal
    Journal of plastic, reconstructive & aesthetic surgery : JPRAS
    URI
    http://hdl.handle.net/10147/200961
    DOI
    10.1016/j.bjps.2008.03.015
    PubMed ID
    18590989
    Abstract
    Autologous breast reconstruction following mastectomy is commonly achieved using the free Transverse Rectus Abdominis Myocutaneous (TRAM) flap. Since its first description, refinements and modifications have resulted in improved operative techniques and more aesthetically pleasing reconstructions. Pre-operative flap design, however, is a relatively new concept that has not received much attention in the literature. Patients who undergo breast reconstruction may have large, ptotic contralateral breasts. In these patients there is a tendency to raise a large abdominal flap in an attempt to achieve symmetry, or simply a larger breast. This has the potential to lead to tight closure of the abdomen and the risk of subsequent wound problems. Reconstructions that are too small or have inadequate ptosis commit the patient to contralateral breast surgery to achieve symmetry. Pre-operatively designing the flap, using a template created from the opposite breast, can help achieve a good match, often reducing the need for contralateral breast surgery. Even when contralateral breast reduction surgery is planned in advance, many of these patients still require, and prefer, a large reconstruction in order to achieve a well-proportioned result. We present a design template that addresses these particular issues and in the senior author's hands has proved to be a very effective technique. Our technique allows raising an abdominal flap of less vertical height than traditionally used (thus reducing the risk of tight abdominal closure) and incorporates an inverted V-shaped flap of skin from the inferior mastectomy skin flap into the reconstruction. This allows more flap tissue to be available to fill the upper poles of the reconstructed breast and at the same time produces good ptosis.
    Item Type
    Article
    Language
    en
    ISSN
    1878-0539
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.bjps.2008.03.015
    Scopus Count
    Collections
    Cork University Hospital

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