Transverse Rectus Abdominis Musculocutaneous Flaps for Lightweights: Is a Pinch Enough?

Abstract

Recent publicity concerning silicone breast implants has fostered patient interest in autogenous breast reconstruction after mastectomy. The transverse rectus abdominus musculocutaneous flap has become the standard for autogenous breast reconstruction. However, very thin patients have not been considered ideal candidates for this procedure due to the paucity of abdominal fat. The use of this procedure in these very thin patients has not been addressed. In patients whose abdominal skin fold thickness was 1 cm or less, we found the procedure to be reliable. However, maximizing the amount of transferred tissue to achieve symmetry necessitates a bipedicled flap. Abdominal fascial closure in these very thin patients is more difficult. Although these patients may not appear to be ideal candidates for the transverse rectus abdominis musculocutaneous flap at first glance, the results have been gratifying and this method of reconstruction is a reliable option.