[The free TRAM (transverse rectus abdominis myocutaneous) flap--a new possibility in breast reconstruction]

Free TRAM slap transfer for breast reconstruction following mastectomy is a functional operation requiring knowledge of aesthetic surgery and mastering of microsurgical techniques. It overcomes the shortcomings of the pedicled TRAM (transverse rectus abdominis myocutaneous flap. By taking advantage of the dominant vascular pedicle (deep inferior epigastric artery and vein) it provides a better vascularization even in zones 3 and 4 and allows a greater freedom in tailoring of the flap. The vascular pedicle is anastomosed to the vessels in axilla providing high filling pressure. Both facts allow the use of free TRAM flap even after irradiation or radical mastectomy. A secondary operation, the "mammilla-areola complex" reconstruction and contralateral breast surgery to achieve symmetry, follow after 3-4 months. Clinical application in 6 post-mastectomy patients is discussed as well as the operative technique of free TRAM flap.