Staged TRAM breast reconstruction: Combining the advantages of tissue expansion with surgical delay

The TRAM flap has become the gold standard in breast reconstruction but suf fers From the disadvantages of poor color match, different texture, and imp aired sensation compared to the normal breast. This study reports on a two- stage procedure to address these problems. The first stage consists of inse rtion of a tissue expander and surgical delay of the TRAM flap. The second stage consists of removal of the tissue expander and transposition of a dee pithelized TRAM flap into the tissue expanded cavity. (The capsule is excis ed.) Four cases of breast reconstruction are reported. The advantage of thi s procedure is that it offers the benefits of tissue expansion, viz, normal color match, texture, and sensation, and in addition, reconstruction is ac hieved with autologous tissue by a pedicled TRAM flap. The vascularity of t he TRAM is enhanced by a surgical delay procedure.