Autologous Reconstruction (Muscle-sparing Free TRAM Flap) 8

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

54 yo 5′ 6″ with previous history of bilateral breast reduction who had developed a right sided breast cancer for which she had lumpectomy and irradiation. The breast had developed this deformity with a chronic draining sinus extending to her chest wall. She had recently 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 greater amount skin and fatty 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. Whereas the pedicled blood supply was well adequate to nourish the left TRAM flap – all of which were carefully evaluated intra operatively. The patient as continued to do extremely well. Second stage had creation of the nipples and further revisions are pending to improve the size and volume match and tattoo the nipple and areolar complexes.