Breast reconstruction with contralateral rectus abdominis myocutaneous flap.

A transverse myocutaneous rectus abdominis flap from the contralateral side has been employed for breast reconstruction in 52 patients. This flap has the advantage of balancing the patient by utilizing skin from an area of relative excess. The blood supply to the flap is based on the superior epigastric vessel and its perforators. The scar of the donor area is acceptable because it falls in the submammary sulcus. The use of a silicone implant can be avoided in some patients because of the adequate bulk of skin, muscle, and fat that is available. Abdominoplasty of the superior abdomen can be obtained during the same operation and can enhance the overall aesthetic results. Breast reconstruction is now possible with either ipsilateral or contralateral upper-abdominal transfer flaps, and further refinement of operative technique using the contralateral upper-rectus abdominis myocutaneous island flap must await further experience.