Immediate breast reconstruction with deepidermalized transverse rectus abdominis musculocutaneous flap after skin-sparing mastectomy

Use of the transverse rectus abdominis musculocutaneous (TRAM) flap for bre ast reconstruction is widely accepted and indications have been well-define d over the past years. More recently, the moratorium prohibiting pre-filled silicone gel implants both in esthetic surgery and in reconstruction breas t surgery, has incited more and more patients to refuse prostheses, even sa line filled implants. Total mastectomy with skin-sparing technique, beyond the limitations dictated by oncology factors which must be taken into accou nt because of the risk of local recurrence, raises the question of immediat e breast reconstruction since implants, when possible, may give unsatisfact ory results either more or less short-term. The deepidermalized TRAM flap i s an interesting alternative for selected patients, especially those with a n adapted abdominal morphology, allowing stable and natural autologous brea st reconstruction. (C) 1999 Elsevier Science Ireland Ltd. All rights reserv ed.