The simultaneous combination of implants and tram flaps for an aesthetically pleasing breast.

In Taiwan, there have quite often been incidences when patients have had more abundant abdominal tissue to make a TRAM flap with a volume larger than the contralateral breast. In these situations, we usually recommend performing contralateral augmentation mammoplasty with a saline implant while undergoing TRAM flap reconstruction. From February 1997 to Mar 2001, 250 breast cancer patients underwent immediate pedicled TRAM flap reconstructions at Kaohsiung Medical University Hospital. Of these, 10 cases not only had TRAM flaps, but also simultaneous insertion of a prosthesis into the contralateral/bilateral breast to form a more pleasing breast mound. These were all saline implants. Each patient was young (aged 31-51 years) and had small to medium sized breasts. During the procedure, the implants were placed in a submuscular pocket formed by the pectoralis major muscle. There were no significant complications or failures. All breasts have remained soft and natural-looking during the follow-up period. Nine of 10 patients appreciated this procedure, and 8 of them would agree to convince other patients of the benefits of this operation. Using pedicled TRAM flaps and saline breast implants can achieve immediate breast reconstruction without the need for prolonged tissue expansion or an obvious back scar. Aesthetic results are excellent and the immediate use of an implant does not appear to pose a risk to the success of the pedicle transfer. It is a good alternative for breast cancer patients with previous hypoplasia of the breasts to achieve simultaneous therapeutic and cosmetic results.