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Updated: Jul 19, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
The "banked" TRAM: a method to insure mastectomy skin-flap survival
Stephen J Kovach1, Gregory S Georgiade
1Department of Plastic, Reconstructive, and Maxillofacial Surgery, Duke University Medical Center, Durham, NC 27710, USA. Stephen.Kovach@Duke.edu
Background:
Necrosis of the skin flaps after mastectomy can be a devastating complication following immediate breast reconstruction with a TRAM flap. Skin-flap loss compromises the aesthetic result and may necessitate revisional surgery. The authors wish to present a simple and effective method to insure mastectomy skin-flap survival.
Methods:
Seven patients over the last 5 years were treated with immediate breast reconstruction with a TRAM flap after skin-sparing mastectomy and had evidence of skin-flap compromise intraoperatively. These patients had their TRAM flaps "banked" under the flaps and returned to the operating room within 72 hours for definitive debridement of the skin flaps, deepithelialization, and insetting of the TRAM.
Results:
In all cases, there was 100% survival of the skin flaps after delayed insetting. There was no skin-flap loss. No patients required additional surgery for revision.
Conclusions:
The banked TRAM is a simple and effective method to insure mastectomy skin flap survival if there is a question of flap viability.
