Surgical delay of TRAM flaps for breast reconstruction

The lower transverse rectus abdominis myocutaneous (TRAM) flap may give excellent results in breast reconstruction using autogenous tissues alone, however, surgical technique is demanding, and the risk of necrosis owing to vascular failure is high. We observed excellent vascularity of the flap in all 20 cases operated upon so far; in all these cases skin island was surgically delayed for one week before final transfer.