Free transverse rectus abdominis musculocutaneous flap for breast reconstruction

The pedicled transverse rectus abdominis musculocutaneous (TRAM) flap is commonly used for breast reconstruction. Although the free TRAM flap has the obvious disadvantages of requiring microsurgical capabilities and risking an all-or-none flap loss situation, its advantages, such as better and more complete perfusion than obtained with a pedicled TRAM flap and greater freedom in reconstruction, are so definitive that it has become our preferred procedure for breast reconstruction. The present paper describes the indications for TRAM flap reconstruction and our surgical technique; 2 cases are presented to illustrate its application. Patients have less postoperative pain, recover from surgery more quickly, and have stronger abdomens postoperatively. The free TRAM flap also results in fewer skin problems and is an easier operation for the patient than pedicled TRAM reconstruction.