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TRAM and Other Flap Procedures
Dalliah M. Black, MD, FACS; Mark W. Clemens, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          • Outcomes

            TERMINOLOGY

            • Abbreviations

              • Transverse rectus abdominis myocutaneous (TRAM) pedicle or free flap
              • Deep inferior epigastric perforator (DIEP) flap
              • Superficial inferior epigastric artery (SIEP) flap
              • Latissimus dorsi myocutaneous (LDM) flap
              • Gluteal free flap: Inferior gluteal artery perforator (IGAP) flap or superior gluteal artery perforator (SGAP) flap
              • Profunda artery perforator (PAP) flap
              • Lateral intercostal artery perforator (LICAP) flap
            • Definitions

              • Autologous breast tissue reconstruction
                • Utilizing patient's tissue from another part of body to reconstruct new breast mound

            PREPROCEDURE

            • Indications

              • Contraindications

                • Preprocedure Imaging

                  • Getting Started

                    PROCEDURE

                    • Procedure Steps

                      POST PROCEDURE

                      • Things to Do

                        • Things to Avoid

                          • Free Flap Monitoring

                            OUTCOMES

                            • Complications

                              Selected References

                              1. Geers J et al: Oncological safety of autologous breast reconstruction after mastectomy for invasive breast cancer. BMC Cancer. 18(1):994, 2018
                              2. Noroozian M et al: Use of screening mammography to detect occult malignancy in autologous breast reconstructions: a 15-year experience. Radiology. 289(1):39-48, 2018
                              3. Santosa KB et al: Long-term patient-reported outcomes in postmastectomy breast reconstruction. JAMA Surg. 153(10):891-99, 2018
                              4. Billig J et al: Should immediate autologous breast reconstruction be considered in women who require postmastectomy radiation therapy? A prospective analysis of outcomes. Plast Reconstr Surg. 139(6):1279-88, 2017
                              5. Pusic AL et al: Patient-reported outcomes 1 year after immediate breast reconstruction: results of the mastectomy reconstruction outcomes consortium study. J Clin Oncol. 35(22):2499-2506, 2017
                              6. Huo J et al: Post-mastectomy breast reconstruction and its subsequent complications: a comparison between obese and non-obese women with breast cancer. Breast Cancer Res Treat. 157(2):373-383, 2016
                              7. Jagsi R et al: Complications after mastectomy and immediate breast reconstruction for breast cancer: a claims-based analysis. Ann Surg. 263(2):219-27, 2016
                              8. Jagsi R et al: Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 32(9):919-26, 2014
                              9. Kronowitz SJ: Current status of autologous tissue-based breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg. 130(2):282-92, 2012
                              10. Clemens M et al: Perforator flaps in breast reconstruction. In Spear SL: Surgery of the Breast: Principles and Art. 3rd ed. Philadelphia: Lippincott-Raven, 2010
                              11. Kronowitz SJ: Redesigned gluteal artery perforator flap for breast reconstruction. Plast Reconstr Surg. 121(3):728-34, 2008
                              12. Selber JC et al: A head-to-head comparison between the muscle-sparing free TRAM and the SIEA flaps: is the rate of flap loss worth the gain in abdominal wall function? Plast Reconstr Surg. 122(2):348-55, 2008
                              13. Rosson GD et al: 3D CT angiography of abdominal wall vascular perforators to plan DIEAP flaps. Microsurgery. 27(8):641-6, 2007
                              14. Nahabedian MY et al: Breast reconstruction with the DIEP flap or the muscle-sparing (MS-2) free TRAM flap: is there a difference? Plast Reconstr Surg. 115(2):436-44; discussion 445-6, 2005
                              15. Guerra AB et al: Breast reconstruction with gluteal artery perforator (GAP) flaps: a critical analysis of 142 cases. Ann Plast Surg. 52(2):118-25, 2004
                              16. Nahabedian MY et al: Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg. 110(2):466-75; discussion 476-7, 2002
                              17. Nahabedian MY et al: Contour abnormalities of the abdomen after breast reconstruction with abdominal flaps: the role of muscle preservation. Plast Reconstr Surg. 109(1):91-101, 2002
                              18. Chang DW et al: Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg. 105(5):1640-8, 2000
                              19. Kaplan JL et al: Cost-based comparison between perforator flaps and TRAM flaps for breast reconstruction. Plast Reconstr Surg. 105(3):943-8, 2000
                              20. Arnez ZM et al: Breast reconstruction using the free superficial inferior epigastric artery (SIEA) flap. Br J Plast Surg. 52(4):276-9, 1999
                              21. Kind GM et al: Abdominal-wall recovery following TRAM flap: a functional outcome study. Plast Reconstr Surg. 99(2):417-28, 1997
                              22. Allen RJ et al: Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg. 95(7):1207-12, 1995
                              23. Allen RJ et al: Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 32(1):32-8, 1994
                              24. Grotting JC: The free abdominoplasty flap for immediate breast reconstruction. Ann Plast Surg. 27(4):351-4, 1991
                              25. Koshima I et al: Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. 42(6):645-8, 1989
                              26. Moon HK et al: The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg. 82(5):815-32, 1988
                              27. Moon HK and Taylor GI. The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg 82: 815–832, 1988
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Preprocedure

                                  • Procedure

                                    • Post Procedure

                                      • Outcomes

                                        TERMINOLOGY

                                        • Abbreviations

                                          • Transverse rectus abdominis myocutaneous (TRAM) pedicle or free flap
                                          • Deep inferior epigastric perforator (DIEP) flap
                                          • Superficial inferior epigastric artery (SIEP) flap
                                          • Latissimus dorsi myocutaneous (LDM) flap
                                          • Gluteal free flap: Inferior gluteal artery perforator (IGAP) flap or superior gluteal artery perforator (SGAP) flap
                                          • Profunda artery perforator (PAP) flap
                                          • Lateral intercostal artery perforator (LICAP) flap
                                        • Definitions

                                          • Autologous breast tissue reconstruction
                                            • Utilizing patient's tissue from another part of body to reconstruct new breast mound

                                        PREPROCEDURE

                                        • Indications

                                          • Contraindications

                                            • Preprocedure Imaging

                                              • Getting Started

                                                PROCEDURE

                                                • Procedure Steps

                                                  POST PROCEDURE

                                                  • Things to Do

                                                    • Things to Avoid

                                                      • Free Flap Monitoring

                                                        OUTCOMES

                                                        • Complications

                                                          Selected References

                                                          1. Geers J et al: Oncological safety of autologous breast reconstruction after mastectomy for invasive breast cancer. BMC Cancer. 18(1):994, 2018
                                                          2. Noroozian M et al: Use of screening mammography to detect occult malignancy in autologous breast reconstructions: a 15-year experience. Radiology. 289(1):39-48, 2018
                                                          3. Santosa KB et al: Long-term patient-reported outcomes in postmastectomy breast reconstruction. JAMA Surg. 153(10):891-99, 2018
                                                          4. Billig J et al: Should immediate autologous breast reconstruction be considered in women who require postmastectomy radiation therapy? A prospective analysis of outcomes. Plast Reconstr Surg. 139(6):1279-88, 2017
                                                          5. Pusic AL et al: Patient-reported outcomes 1 year after immediate breast reconstruction: results of the mastectomy reconstruction outcomes consortium study. J Clin Oncol. 35(22):2499-2506, 2017
                                                          6. Huo J et al: Post-mastectomy breast reconstruction and its subsequent complications: a comparison between obese and non-obese women with breast cancer. Breast Cancer Res Treat. 157(2):373-383, 2016
                                                          7. Jagsi R et al: Complications after mastectomy and immediate breast reconstruction for breast cancer: a claims-based analysis. Ann Surg. 263(2):219-27, 2016
                                                          8. Jagsi R et al: Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 32(9):919-26, 2014
                                                          9. Kronowitz SJ: Current status of autologous tissue-based breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg. 130(2):282-92, 2012
                                                          10. Clemens M et al: Perforator flaps in breast reconstruction. In Spear SL: Surgery of the Breast: Principles and Art. 3rd ed. Philadelphia: Lippincott-Raven, 2010
                                                          11. Kronowitz SJ: Redesigned gluteal artery perforator flap for breast reconstruction. Plast Reconstr Surg. 121(3):728-34, 2008
                                                          12. Selber JC et al: A head-to-head comparison between the muscle-sparing free TRAM and the SIEA flaps: is the rate of flap loss worth the gain in abdominal wall function? Plast Reconstr Surg. 122(2):348-55, 2008
                                                          13. Rosson GD et al: 3D CT angiography of abdominal wall vascular perforators to plan DIEAP flaps. Microsurgery. 27(8):641-6, 2007
                                                          14. Nahabedian MY et al: Breast reconstruction with the DIEP flap or the muscle-sparing (MS-2) free TRAM flap: is there a difference? Plast Reconstr Surg. 115(2):436-44; discussion 445-6, 2005
                                                          15. Guerra AB et al: Breast reconstruction with gluteal artery perforator (GAP) flaps: a critical analysis of 142 cases. Ann Plast Surg. 52(2):118-25, 2004
                                                          16. Nahabedian MY et al: Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg. 110(2):466-75; discussion 476-7, 2002
                                                          17. Nahabedian MY et al: Contour abnormalities of the abdomen after breast reconstruction with abdominal flaps: the role of muscle preservation. Plast Reconstr Surg. 109(1):91-101, 2002
                                                          18. Chang DW et al: Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg. 105(5):1640-8, 2000
                                                          19. Kaplan JL et al: Cost-based comparison between perforator flaps and TRAM flaps for breast reconstruction. Plast Reconstr Surg. 105(3):943-8, 2000
                                                          20. Arnez ZM et al: Breast reconstruction using the free superficial inferior epigastric artery (SIEA) flap. Br J Plast Surg. 52(4):276-9, 1999
                                                          21. Kind GM et al: Abdominal-wall recovery following TRAM flap: a functional outcome study. Plast Reconstr Surg. 99(2):417-28, 1997
                                                          22. Allen RJ et al: Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg. 95(7):1207-12, 1995
                                                          23. Allen RJ et al: Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 32(1):32-8, 1994
                                                          24. Grotting JC: The free abdominoplasty flap for immediate breast reconstruction. Ann Plast Surg. 27(4):351-4, 1991
                                                          25. Koshima I et al: Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. 42(6):645-8, 1989
                                                          26. Moon HK et al: The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg. 82(5):815-32, 1988
                                                          27. Moon HK and Taylor GI. The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg 82: 815–832, 1988