Thoracoacromial vessels as the recipients for supercharged muscle-sparing transverse rectus abdominis myocutaneous...

We describe the use of the thoracoacromial vessels in microvascular transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction in two cases. The thoracoacromial vessels, used as recipient vessels for supercharged TRAM flaps, offer several advantages. Their location high on the anterior chest wall is ideal for anastomotic repair under the microscope and lends itself to medial placement of the TRAM flap. The thoracoacromial vessels are relatively easily exposed and are suited for microsurgical anastomosis by virtue of their caliber and topology. The dissection of these vessels takes less time than either the internal mammary or thoracodorsal systems. The location of the thoracoacromial vessels allows the flexibility of using either the ipsilateral pedicle for supercharging (deep inferior epigastric vessels on the same side as the superior epigastric pedicle) or contralateral supercharging (deep inferior epigastric vessels on the opposite side of the superior epigastric pedicle). The thoracoacromial vessels make an excellent alternative recipient for microvascular anastomosis in breast reconstruction.