Secondary use of the rectus muscle pedicle for TRAM flap volume deficiencies

The residual subxiphoid rectus muscle pedicle was rotated secondarily to a position underneath the breast mound in 13 patients who had previously undergone transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction. The indications for this maneuver were the presence of a subxiphoid muscle bulge and a deficiency of volume or projection of the TRAM flap breast mound. This revisional surgery was performed at least 8 weeks after the TRAM flap, typically at the time of nipple-areolar reconstruction. Minor to moderate volume deficiencies were corrected and aesthetic improvement was substantial. There were no major complications. The danger of vascular compromise to the breast mound itself or to the remobilized muscle appears to be minimal, although the need for caution in the previously irradiated chest wall should be emphasized.