Immediate reconstruction is becoming increasingly popular because it g
ives a better aesthetic result for breast reconstruction, and is more
economical and convenient for patients than delayed reconstruction. De
layed breast reconstructions are still needed in 80% of mastectomized
patients under 40 years and in half the women under 54 years-at least
in Finland. This article discusses the technique of and contraindicati
ons for the free transverse rectus abdominis myocutaneous (TRAM) flap
technique based on the author's experience with over 300 free TRAM ope
rations. The pedicled TRAM and the deep inferior epigastric artery (DI
EA) perforator flap are also discussed.