TRAM flap breast reconstruction after abdominal liposuction

The transverse rectus abdominis musculocutaneous (TRAM) flap has become the gold standard of autologous breast reconstruction. It is typically a low-risk procedure with few surgical contraindications. A relative contraindication, however, is prior liposuction of the abdomen. The contention has been that the trauma of the liposuction procedure can damage or destroy the musculocutaneous perforators that supply circulation to the TRAM flap skin paddle. The authors present 2 patients who previously underwent suction-assisted abdominal lipectomy and, after mastectomies, successfully underwent unilateral breast reconstruction using single-pedicle TRAM flaps. They also examine the literature that supports the feasibility of this procedure.