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Minimizing Donor-Site Morbidity Following Bilateral Pedicled TRAM Breast Reconstruction With the Double Mesh Fold Over Technique

Bharti, Gaurav MD*; Groves, Leslie MD; Sanger, Claire DO; Thompson, James MD; David, Lisa MD; Marks, Malcolm MD

doi: 10.1097/SAP.0b013e31828569c0
Clinical Papers
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Introduction Transverse rectus abdominus muscle flaps (TRAM) can result in significant abdominal wall donor-site morbidity. We present our experience with bilateral pedicle TRAM breast reconstruction using a double-layered polypropylene mesh fold over technique to repair the rectus fascia.

Methods A retrospective study was performed that included patients with bilateral pedicle TRAM breast reconstruction and abdominal reconstruction using a double-layered polypropylene mesh fold over technique.

Results Thirty-five patients met the study criteria with a mean age of 49 years old and mean follow-up of 7.4 years. There were no instances of abdominal hernia and only 2 cases (5.7%) of abdominal bulge. Other abdominal complications included partial umbilical necrosis (14.3%), seroma (11.4%), partial wound dehiscence (8.6%), abdominal weakness (5.7%), abdominal laxity (2.9%), and hematoma (2.9%).

Conclusions The TRAM flap is a reliable option for bilateral autologous breast reconstruction. Using the double mesh repair of the abdominal wall can reduce instances of an abdominal bulge and hernia.

From the *Division of Plastic and Reconstructive Surgery, Quillen College of Medicine at East Tennessee State University, Johnson City, TN; and †Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Health, Winston-Salem, NC.

Received August 14, 2012, and accepted for publication, after revision, December 30, 2012.

This manuscript was presented at the 55th Annual Scientific Meeting of the Southeastern Society of Plastic and Reconstructive Surgeons, Amelia Island, FL, June 2012.

Conflicts of interests and sources of funding: none declared.

Reprints: Malcolm Marks, MD, FACS, Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, NC 27157-1071. E-mail: mmarks@wfubmc.edu.

© 2013 by Lippincott Williams & Wilkins