Bipedicled TRAM flap with rectus abdominis muscle preservation below the arcuate line without reinforcing mesh

Background: The use of a bipedicled transverse rectus abdominis myocutaneous (TRAM) flap in breast reconstructions has required the prophylactic use of mesh in the lower seg ment of the hypogastrium, because of the frequency of bulging and herniations in the middle to long term. This study aims to record a technical procedure routinely used in breast recons­ tructions: bipedicled TRAM flap without previous autonomization, with to tal preservation of the rectus abdominis and pyramidal muscles in their sheaths at the limit of the arcuate line without the use of mesh, and without secondary herniation of the abdominal wall in the long term. Methods: Bipedicled TRAM flap, without the use of mesh and, through the preservation of both the rectus abdominis muscles in their sheaths from the arcuate line to the pubis, without the presence of bulging or herniation in the lower segment of the hypogastrium, was performed on 11 patients. The plication of the musculoaponeurotic layer in the hypogastrium followed a specific surgical routine after the migration of the rectus abdominis, with complementary suture of its aponeurosis in the respective arcuate lines, and with the necessary reinforcement to avoid either the use of mesh or the onset of bulging and herniation. Results: The aesthetic result obtained in all cases was considered satisfactory both by patients and by the surgical staff. The patients did not develop any type of secondary herniation or bulging in the abdominal wall in the postoperative fol ­ low­up period. Conclusions: The bipedicled TRAM flap technique with preservation of the rectus abdominis muscles below the arcuate line and without the use of reinforcement mesh provides satisfactory results that are maintained in the middle to long term, without the development of any secondary herniation in the abdominal wall.