Breast Reconstruction Using Bipedicled free TRAM in Patients with Subumbilical Vertical Midline Scar.

Seo, Il Beom; Oh, Kap Sung; Bang, Sa Ik; Hyon, Won Sok; Mun, Goo Hyun; Lee, Ji Hyuk; Ha, Bom Jun

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2004;31(4):460-466.
Published online July 1, 2004.

Breast Reconstruction Using Bipedicled free TRAM in Patients with Subumbilical Vertical Midline Scar.

Il Beom Seo, Kap Sung Oh, Sa Ik Bang, Won Sok Hyon, Goo Hyun Mun, Ji Hyuk Lee, Bom Jun Ha

¹Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea. tandco@mdhouse.com
²ADEL Plastic Surgery, Korea.

Abstract

Breast reconstruction using TRAM flap after mastectomy has been widely adopted and regarded as a gold standard method. In patients with the abdominal midline scar, insufficient blood circulation to regions contralateral to the pedicle disables inclusion of them in the TRAM flap design. So modifications including Double- pedicled TRAM, Super-charged, Turbo-charged, Bipedicled free TRAM et al. have been attempted to resolve the problem of circulatory interruption by midline scar. The authors designed a new bipedicled free TRAM flap to avoid limitations like epigastric buldging, significant abdominal weakness and complexity of flap insetting. The two donor arteries(right and left deep inferior epigastric arteries) are anastomosed to the proximal and distal ends of divided internal mammary arteries using the reverse flow. Vein anastomoses were performed in the same manner through the divided venae comitantes. Two patients having infraumbilical midline scar underwent breast reconstruction using author`s new flap. Flaps survived without fat necrosis or partial flap loss in both patients and their results in aesthetic aspects were very satisfactory. Compared to previous method for breast reconstruction of patients having infraumbilical midline scar, author's new method is useful and effective in terms of the aesthetic and technical aspect.

Keywords: Bipedicled free TRAM; Infraumbilical midline scar; Reverse flow