The transverse myocutaneous gracilis flap is a safe, fast flap for reconstruction after benign and malignant breast disease. It combines a constant vascular pedicle with soft subcutaneous tissue that has breast-like characteristics.

Hereditary thrombophilia sums up a large number of haemostatic disorders, which cause thrombosis independently to external influences. The main cases of hereditary thrombophilias are the hereditary antithrombin defect, the activated protein C resistance, the hereditary protein C defect, the hereditary protein S defect, the antiphospholipid antibody syndrome, the hyperhomocysteinaemia, the increased factor VIII activity and the prothrombin-G20210A-polymorphism. We present a patient who was amputated in both breasts due to cancer. A bilateral microvascular TRAM-flap was planned as primary reconstruction on one breast and secondary reconstruction on the other breast. However in the operation the flap vessels revealed irreversible thromboses so that the intended reconstruction could not be completed in this operation. Postoperatively, a combined hereditary thrombophilia was diagnosed: heterocygote activated protein C resistance, antiphospholipid antibody syndrome and hyperhomocysteinaemia.

In our department, the TMG has become the most preferred flap for breast reconstruction besides the TRAM/DIEP. Especially slim patients with small breasts or a history of surgery on the abdominal wall are ideal candidates. The tissue from the medial thigh is very similar to the breast tissue. The constant vascular anatomy makes it easy to harvest the flap. The resulting scar is well hidden in the patients' underwear.