Since the first report in 1982 by Hartrampf, Scheflan and Black [2] on
the TRAM flap, it has had a profound impact on the management of post
-mastectomy deformity and the reconstruction of numerous chest wall de
formities. A retrospective analysis of 10 years of experience of two s
urgeons covering a total of 1079 flaps is presented. Lessons learned r
egarding patient evaluation and preparation, advances in operative tec
hniques, and post-operative care and results are assessed and discusse
d.