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. 2012 Jan;39(1):3-10.
doi: 10.5999/aps.2012.39.1.3. Epub 2012 Jan 15.

Breast Reconstruction with Microvascular MS-TRAM and DIEP Flaps

David W Chang  1
Affiliations

Breast Reconstruction with Microvascular MS-TRAM and DIEP Flaps

David W Chang. Arch Plast Surg. 2012 Jan.

Abstract

The free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) and deep inferior epigastric perforator (DIEP) flaps involve transferring skin and subcutaneous tissue from the lower abdominal area and have many features that make them well suited for breast reconstruction. The robust blood supply of the free flap reduces the risk of fat necrosis and also enables aggressive shaping of the flap for breast reconstruction to optimize the aesthetic outcome. In addition, the free MS-TRAM flap and DIEP flap require minimal donor-site sacrifice in most cases. With proper patient selection and safe surgical technique, the free MS-TRAM flap and DIEP flap can transfer the lower abdominal skin and subcutaneous tissue to provide an aesthetically pleasing breast reconstruction with minimal donor-site morbidity.

Keywords: Free tissue flaps; Mammaplasty; Mastectomy.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Falp harvesting A free muscle-sparing transverse rectus abdominis myocutaneous falp.
Fig. 2
Fig. 2
Falp harvesting A free deep inferior epigastric perforator flap.
Fig. 3
Fig. 3
The recipient site An exposure of the internal mammary vessels. U, up; L, lateral; M, medial; IMA, internal mammary artery; IMV, internal mammary vein.
Fig. 4
Fig. 4
Shaping of delyed breast reconstruction (A) Preoperative marking. (B) Delayed reconstruction with a free muscle-sparing transverse rectus abdominis myocutaneous flap.
Fig. 5
Fig. 5
Management of the donor site (A) Bilateral breast reconstruction with a free muscle-sparing transverse rectus abdominis myocutaneous flap and a free deep inferior epigastric perforator flap. (B) Donor site after the flaps are harvested. (C) Fascia is closed primarily and tension free.
Fig. 6
Fig. 6
Case (A) A patient with left breast cancer. (B) A long term result following immediate left breast reconstruction with a free deep inferior epigastric perforator flap and subsequent nipple reconstruction. The patient tattooed her donor site scar.
See this image and copyright information in PMC

References

    1. Holmstrom H. The free abdominoplasty flap and its use in breast reconstruction: an experimental study and clinical case report. Scand J Plast Reconstr Surg. 1979;13:423–427. - PubMed
    1. Roehl KR, Baumann DP, Chevray PM, et al. Evaluation of outcomes in breast reconstructions combining lower abdominal free flaps and permanent implants. Plast Reconstr Surg. 2010;126:349–357. - PubMed
    1. Chang DW, Reece GP, Wang B, et al. Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction. Plast Reconstr Surg. 2000;105:2374–2380. - PubMed
    1. Chang DW, Wang B, Robb GL, et al. Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg. 2000;105:1640–1648. - PubMed
    1. Kim JY, Chang DW, Temple C, et al. Free transverse rectus abdominis musculocutaneous flap breast reconstruction in patients with prior abdominal suction-assisted lipectomy. Plast Reconstr Surg. 2004;113:28e–31e. - PubMed