c l i n i c a l f o l i o s : d i s c u s s i o n

Bilateral TRAM



Related narrative: Bilateral TRAM Breast Reconstruction

Bilateral TRAM breast reconstruction has been advocated as an alternative to implants for patients at high risk for developing breast cancer who are considering bilateral prophylactic subcutaneous (total) mastectomy. Preliminary studies have shown a significant decreased cumulative risk (85%) and up to a 5 year increase in longevity with prophylactic mastectomy, and advocates of the TRAM reconstruction suggest that the availability of the latter might encourage the former. The procedure is also indicated for patients with complications from prior implants, as in this case, with or without supplementary saline implants. The procedure takes an average of 7 hours. Bilateral transfer of the entire rectus muscle has not been associated with significant increased local complications, but is associated with a slightly increased risk of abdominal wall hernia. Bilateral free TRAM reconstruction can be used in cases with contraindications for pedicled TRAM (smokers, abdominal scars, the thin and obese) and as surgeon's and patient's choice for other advantages (more robust blood supply supporting a larger skin area, less rectus muscle sacrifice, no subQ tunnel).


A comparison of morbidity from bilateral, unipedicled and unilateral, unipedicled TRAM flap breast reconstructions.
Paige KT - Plast Reconstr Surg - 1998 Jun; 101(7): 1819-27

Bilateral TRAM flaps for the reconstruction of the post implantectomy/capsulectomy breast deformity.
Spiro SA - Aesthetic Plast Surg - 1996 Jul-Aug; 20(4): 315-8

The combined use of the TRAM and expanders/implants in breast reconstruction.
Serletti JM - Ann Plast Surg - 1998 May; 40(5): 510-4

Abdominal-wall recovery following TRAM flap: a functional outcome study.
Kind GM - Plast Reconstr Surg - 1997 Feb; 99(2): 417-28

Simultaneous Bilateral Breast Reconstruction With the Transverse Rectus Abdominus Musculocutaneous Free Flap, Khouri RK et. al., Annals of Surgery, 226(1), July 1997:25-34.

This page was last modified on 27-Dec-2000.