Precision transverse rectus abdominis muscle flap breast reconstruction - A reliable technique for efficient preoperative planning

The advent of the skin-sparing mastectomy has had a profound impact on autogenous breast reconstruction by making it a "filling" procedure rather than a "shaping" procedure. The reliability of the skin-sparing mastectomy has allowed plastic surgeons to improve the accuracy and efficiency of the transverse rectus abdominis muscle (TRAM) flap. The purpose of this study is to describe our experience with a novel technique for the preoperative planning of pedicled TRAM flap breast reconstructions. All patients are preoperatively marked in the upright position. Measurements of the key anatomic boundaries of the breast are carefully transferred to the abdomen to reliably recreate the size and shape of the reconstructed breast. The markings are tailored to each patient with specific design variations accounting for such patient characteristics as the need for postoperative radiation, breast ptosis, bilateral reconstruction, and previous biopsy scars. We performed a retrospective review of 472 patients who underwent pedicled TRAM flap breast reconstruction by a single surgeon utilizing the Precision TRAM marking technique between 1996 and 2007. The average of follow-up was 3.4 years. The average patient age was 48 years. The average surgical time was 2.8 hours for unilateral reconstructions. The overall incidence of complications was quite low. Importantly, the rate of mastectomy skin loss was 1.2%. Other TRAM-related complications were similar to those reported in the literature. The Precision TRAM technique for preoperative marking can improve the efficiency and accuracy of TRAM flap breast reconstruction. We have enjoyed overall excellent esthetic results with minimal complications utilizing this technique in a wide variety of patients.