The bipedicled free TRAM flap

The Efficacy of Bilateral Lower Abdominal Free Flaps for Unilateral Breast Reconstruction

“…30 -40,52 Although the technical aspects of using bilateral lower abdominal flaps for unilateral reconstruction are really no different for immediate or delayed reconstructions, it is important to emphasize that the use of bilateral flaps increases the magnitude of operative complexity and the potential morbidity of the breast reconstruction, especially the abdominal donor site. 34,35,37,40,[52][53][54][55][56][57][58][59][60][61][62][63] In delayed reconstructions, bilateral lower abdominal flaps provide an optimal ability to replicate the missing skin and subcutaneous tissues requisite to the restoration of the total breast. This technique allows the surgeon tremendous latitude in planning a course for reconstruction that far exceeds the capabilities of traditional efforts.…”

“…In these circumstances, bipedicled flaps from the lower abdomen may be used to optimize the amount of well-perfused tissue for reconstruction. [30][31][32][33][34][35][36][37][38][39][40][41] This report examines our retrospective experience with the use of bilateral free flaps for unilateral breast reconstruction. breast reconstruction performed by the authors at the University of Texas M. D. Anderson Cancer Center and the University of Chicago Hospitals between January of 1994 and December of 2005.…”

Bilateral breast reconstruction with a pedicled transverse rectus abdominis myocutaneous flap after subcutaneous mastectomy for symptomatic injected breasts

“…Problems with the conventional pedicled TRAM flap are unreliable distal perfusion and distortion or obstruction of the pedicle [17]. Free muscle-sparing TRAM flaps might provide some benefit in reducing partial flap loss in obese patients, but overall complication rates were not significantly different between free muscle-sparing or pedicled TRAM flaps [18].…”

Advances in Autogenous Breast Reconstruction

“…Because of these anatomic variations in the SIE vessels, a rational approach was recommended when considering harvesting of the flap. 15,16,18 The lower incision line was placed more inferiorly towards the pubic tubercle compared with DIEP flap markings to better visualize the vessels at this level. The upper incision of the flap should be lower too, to close the abdomen without important tension.…”