Introduction: As aesthetic surgery of the abdomen becomes increasingly popular, the safety of transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction in the context of prior surgery of the abdominal wall becomes a concern. Recent case studies have highlighted the potential utility of pedicled TRAM reconstruction following suction-assisted lipectomy (SAL) of the abdomen.

Hypothesis: Microvascular TRAM breast reconstruction can be performed in select patients who have undergone prior SAL of the abdomen.

Method: Two patients who had had SAL of the abdomen 6 and 10 years ago elected to undergo autogenous breast reconstruction with microvascular TRAM flaps. Pre-operative evaluation included doppler ultrasound to confirm the patency of the perforating vessels of the abdominal wall. Intra-operative technique was modified so that both medial and lateral row perforators were incorporated into the flap to render a more robust flap for transfer.

Results: Patients demonstrated a good cosmetic outcome with no flap loss and no evidence of fat necrosis. No donor site complications occurred.

Conclusion: In select patients TRAM flap breast reconstruction can be safely performed following SAL of the abdomen. Doppler ultrasound assessment of abdominal perforators and optimization of flap vascularity are modifications that may enhance the reconstructive outcome.