TRAM Flap Breast Reconstruction Case #2573

Bilateral breast reconstruction with right free TRAM flap and left pedicled TRAM flap.

54 year old 5′ 6″ with previous history of bilateral breast reduction who had developed right sided breast cancer for which she had lumpectomy and irradiation. The right breast had osteoradionecrosis with a chronic draining sinus extending to her chest wall. Several years later she developed mammographic changes at her left breast and therefore elected to undergo a bilateral mastectomy with same time reconstruction of both breasts. The patient had a skin sparing mastectomy at her left breast hence the different skin paddles seen on the final reconstruction. She needed a greater amount of skin and volume from the abdomen to resurface both missing breast volume as well as skin envelope on her right side. Therefore, the abdominal wall donor site was differentially allocated to create symmetry as best possible. Given free microvascular reconstruction at her right breast, the flap was freely contoured and shaped to resemble an uplifted and youthful looking breast. Several months after she had creation of the nipples and followed by tattooing the nipple and areolar complexes.