Breast reconstruction with abdominal flaps after abdominoplasties

After the reported safe transverse rectus abdominis myocutaneous (TRAM) fla p after liposuction of the abdomen, two cases of bipedicled reconstruction with this flap after abdominoplasty were successfully performed. This opera tion has not previously been considered possible because of the transection of the perforator arteries during the undermining of the abdomen. To exami ne the possible reperfusion of the perforator arteries, the authors studied the perforator arteries of 10 patients before they underwent abdominoplast y and at 1 week, 3 months, and 6 months after the operation. The arteries w ere studied with color-duplex scanning and power Doppler, using 10-MHz supe rficial probes, and their position was marked on a map. A cadaver study of a woman who had had an abdominoplasty 10 years before her death is also pre sented. In every patient, reperfusion of all perforator arteries was docume nted. starting from the control at I month. In no case was the caliber of t he reperfused vessels more than 40 percent of the original diameter (maximu m: 0.53 mm). This was also confirmed by the cadaver study. In conclusion, a fter an abdominoplasty operation, constant reperfusion of the perforator ar teries of the rectus muscles occurs. However, the diameter of the arteries may not be enough to provide the necessary blood supply for a TRAM flap, wh ich is therefore strongly discouraged by the authors after abdominoplasty i n favor of a vertical rectus abdominis muscle (VRAM) flap. A liposuction, w hich does not necessarily disrupt the perforators, is not an absolute contr aindication for a TRAM flap, provided that an accurate color-duplex scannin g study is done.