TRAM Flap Breast Reconstruction.

The transverse rectus abdominus musculocutaneous flap, or TRAM flap, has revolutionized the plastic and reconstructive surgeon's approach to breast reconstruction. Since its first clinical description by Hartrampf, Schellan, and Black in 1982, the TRAM flap has become today's standard for autogenous tissue breast reconstruction. In light of the recent controversy regarding silicone breast implants, the use of autogenous tissue for breast reconstruction has become even more popular. It is the wide belief of most plastic and reconstructive surgeons that, by using autogenous tissue, the reconstructed breast has a more natural shape and contour. Furthermore, patient satisfaction is extremely high and problems inherent with implants, such as capsular contracture, are avoided. With newer technology and a stronger emphasis on self-examination and routine mammographic screening, breast cancer is currently being detected at earlier stages. Because of this, more and more women with diagnosed breast cancer are undergoing breast conserving surgery and radiotherapy. Patients with larger tumors, in more advanced stages, often require a more extensive operation, namely a modified radical mastectomy. The TRAM flap, in an immediate or delayed setting, is an ideal technique for the reconstruction of a modified radical mastectomy defect. We at the Breast Care Center of Mount Zion Medical Center of U.C. San Francisco are extremely pleased with the results of immediate breast reconstruction using the TRAM flap techniques.