Our patient is a 45-year-old female with a past medical history of T2N1M0 (stage IIb, grade 3), ER positive, PR negative, HER2/NEU positive infiltrating ductal carcinoma of the left breast at the age of 38 treated with left modified radical mastectomy transverse rectus abdominis muscle (TRAM) flap reconstruction, and later with a latissimus flap following the development of a thrombus in the original TRAM flap
. Following surgical therapy, she received doxorubicin and cyclophosphamide, followed by paclitaxel and trastuzumab.
"I had three failed implant operations, which all sunk into my chest, then I learnt about a 'tram flap
' operation after watching the TV show Embarrassing Bodies." A tram flap
involves moving skin, fat, blood vessels, and muscle from the lower abdomen and then reconstructing them to form breasts.
Accordingly, the involved skin was excised with a wide local margin, and the pectoralis major muscle was removed en block, followed by immediate reconstruction with TRAM flap
Kim, "The effects of botulinum toxin A on survival of rat TRAM flap
with vertical midline scar," Annals of Plastic Surgery, vol.
Reconstruction of an extensive thigh defect with the paraumbilical TRAM flap
. Annals of Plastic Surgery.2003; 519 (1): 91-96.
Aplasia of the breast"reconstruction using a free tram flap
. Acta Chir Plast 2001; 43: 39-41.
Komorowska-Timek et al., "Improvement of skin paddle survival by application of vascular endothelial growth factor in a rat TRAM flap
model," Annals of Plastic Surgery, vol.
Immediate breast reconstruction using autologous tissue was performed in more than 90% of cases (TRAM flap
in 55% and latissimus dorsi myocutaneous flap in 36% cases), whereas silicone implants were used in 8.8% of cases only.
A TRAM flap
procedure uses tissue and muscle from the lower abdomen.
He laid out the options: saline implant, TRAM flap
(which uses skin, fat, and muscle from the belly region to construct a breast), or LAT flap (which uses skin, fat, and muscle from the back region to construct a breast).
The other option presented to me was the Tram Flap
procedure, which was also unacceptable.
The product can be used in several indications such as paraesophageal/hiatal hernia repair, abdominal wall reconstruction, abdominoperineal resection, stoma reversal and breast reconstruction using pedicled TRAM flap