The use of the transverse rectus abdominis musculocutaneous flap after abdominoplasty

Approximately ten years after abdominoplasty, transverse rectus abdominis musculocutaneous (TRAM) flaps were utilized for breast reconstruction in two patients. Both had considerable excess lower abdominal tissue that they wanted removed. We assumed that a new perforating system had developed that might support the lower abdominal skin even though all the original perforators would have been sacrificed at the time of the abdominoplasty. The two patients had successful breast reconstructions performed utilizing bipedicle TRAM flaps with full survival of the flaps. However, we do not recommend the general use of TRAM flaps after abdominoplasty.