An alternative technique for managing the lower breast skin during secondary breast reconstruction with a TRAM flap

During secondary breast reconstruction with a transverse rectus abdominis musculocutaneous (TRAM) flap, the native breast skin between the mastectomy scar and inframammary crease is usually left intact, excised, or deepithelialized. The authors have developed transposition flaps utilizing this skin and subcutaneous tissue in selected patients. This technique is most useful in patients who present for secondary reconstruction whose remaining lower breast skin may have contracted or in patients who should have a vertically inset TRAM flap but do not have a wide enough flap relative to the length of the inframammary crease. Although the authors use this technique infrequently due to additional scars placed on the breast, it is a useful technique to add to the armamentarium of the reconstructive surgeon.