The mastectomy specimen as a model for TRAM flap fabrication in immediate breast reconstruction

Traditionally, most of transverse rectus abdominis musculocutaneous (TRAM) flap shaping takes place after transfer of the flap to the chest. As skin-sparing mastectomies become more commonplace, flap tailoring becomes a more difficult and lengthy process due to lack of exposure through these small incisions. Immediate breast reconstruction was performed on 40 patients using the mastectomy specimen as a model for TRAM flap fabrication. Detailed measurements of the specimen were taken and a template was created as a guide for shaping the flap. All flaps were shaped on the abdomen, and additional tailoring was not necessary after transfer to the chest. Significant differences in weight were recorded between the shaped flap and the specimen. Size, shape, and orientation were found to be more reliable parameters in matching the flap to the specimen than approximating their weights. This approach allows for greater accuracy in shaping the flap, reduces operative time, and avoids flap manipulation after transfer.