Preoperative TRAM flap planning for postmastectomy breast reconstruction

The techniques for transverse rectus abdominis musculocutaneous flap planning, which have previously been described in international literature, do not provide adequate guidelines for preoperative marking that can be followed in patients with different types of contralateral breast. Because in most patients we tend to reconstruct the new breast on the model of the contralateral one without significant changes in the patient's body image, some parameters were needed that could provide adequate preoperative marking. The technique we describe for preoperative planning is simple and reliable and can be used in most patients. It allows immediate deepithelialization and tailoring of the dermoadipose extensions of the flap at the beginning of the operation. In our experience this type of preoperative marking has significantly reduced operative time and the need for secondary correction and contralateral mammaplasty. The incidence of marginal flap necrosis and liponecrosis has also been reduced because minimal contralateral random portion of the skin island is used.