Breast Reconstruction Using a TRAM Free Flap with a Mini-Abdominoplasty Design and Flap Beveling

Breast cancer is the most common malignant disease in the female population. Significant psychological, social, and sexual morbidity can follow mastectomy for treatment of breast cancer owing to the realization of the life-threatening disease as well as impaired body image [1]. Breast reconstruction improves the patient’s self-confidence after the loss of a breast from cancer or trauma [2]. Of the breast reconstructions using autologous tissue, the most commonly used flaps involve a deep inferior epigastric perforator (DIEP) flap or free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap, both of which allow a sufficient volume of tissue. However, owing to the long transverse scar between the anterior superior iliac spines (ASIS), patients hesitate to choose breast reconstruction using a free MS-TRAM or DIEP flap. Furthermore, for a traditional reconstruction using a free MS-TRAM flap, the donor site must be dissected to the subcostal area in order to close the wound after elevating the flap and form the neo-umbilicus. As a result, there is an increased risk of donor site morbidity, such as pain, hematoma, or seroma. Moreover, a significant amount of the flap is discarded. In an attempt to address these shortcomings, we developed a novel method using a mini-abdominoplasty for flap elevation, and Tae Hoon Kim, Kyung Won Minn, Ung Sik Jin