Preferential use of the ipsilateral pedicle in TRAM flap breast reconstruction

Breast reconstruction utilizing the ipsilateral transverse rectus abdominis musculocutaneous (TRAM) flap provides superior results when compared with contralaterally based reconstructions by preserving the medial inframammary fold and eliminating the perixiphoid bulge. Additionally, a longer pedicle can be obtained using the ipsilateral TRAM, thereby allowing greater mobility and flexibility during flap transposition. These findings are based on a retrospective review of 50 consecutive ipsilateral TRAM flap reconstructions in 38 patients. The mean patient age was 45.4 years and mean follow-up was 8.6 months. Thirty-two flaps were performed as immediate reconstructions and 18 flaps were delayed. No patient suffered total flap loss, whereas partial flap loss was observed in three flaps. One patient required suture removal to alleviate venous congestion of the flap. No patient developed a postoperative hernia, but 1 patient required removal of a polytetrafluoroethylene onlay patch following graft exposure. This technique achieves aesthetically pleasing results with acceptable morbidity, allows greater flap mobility without disruption of the medial inframammary fold or creation of a perixiphoid bulge, and is our method of choice for TRAM flap breast reconstruction.