SECONDARY USE OF THE RECTUS MUSCLE PEDICLE FOR TRAM FLAP VOLUME DEFICIENCIES

The residual subxiphoid rectus muscle pedicle was rotated secondarily to a position underneath the breast mound in 13 patients who had previ ously undergone transverse rectus abdominis musculocutaneous (TRAM) fl ap breast reconstruction, The indications for this maneuver were the p resence of a subxiphoid muscle bulge and a deficiency of volume or pro jection of the TRAM flap breast mound, This revisional surgery was per formed at least 8 weeks after the TRAM flap, typically at the time of nipple-areolar reconstruction. Minor to moderate volume deficiencies w ere corrected and aesthetic improvement was substantial, There were no major complications. The danger of vascular compromise to the breast mound itself or to the remobilized muscle appears to be minimal, altho ugh the need for caution in the previously irradiated chest wall shoul d be emphasized.