METHOD OF BREAST RECONSTRUCTION WITH A DEEPITHELIALIZED TRAM FLAP VIATHE ABDOMINAL APPROACH FOR FAILED IMPLANT SALVAGE IN POSTMASTECTOMY PATIENTS

Postmastectomy reconstruction of breasts is one of the most commonly p erformed procedures of the plastic surgeon today. Tissue expansion wit h subsequent implant placement, transverse rectus abdominis musculocut aneous (TRAM) flaps, latissimus dorsi flaps, gluteal flaps, Ruben's fa t pad flaps, and free flaps from other areas have all been utilized wi th consistently good aesthetic results. One special class of patient i s the woman who has undergone breast reconstruction with tissue expans ion, with or without subsequent implant placement, who then receives e xternal beam radiation therapy. Capsular contraction frequently compli cates this therapy. In the past, women have undergone capsulotomy or c apsulectomy with replacement of the implant. Recently, women are more reluctant to have foreign tissue in their bodies and are opting for au tologous tissue reconstructions. TRAM reconstruction following removal of implants has been previously reported. A new approach to the place ment of the TRAM flap after implant reconstruction via the abdominal a pproach, with avoidance of any incision on the breast itself, is prese nted. This is especially important in a patient who has evidence of ra diation damage to the skin, placing any incision through the treated t issue at risk.