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Bipedicled TRAM is performed for individuals that have an acquired breast absence desiring unilateral autologous tissue breast reconstruction. The primary indications for bipedicled TRAM include cases where larger tissue volumes are required for reconstruction, history of chest wall irradiation, or history of lower abdominal wall incision. This activity reviews the use of bipedicled TRAM flaps for unilateral breast absence and highlights the role of the interprofessional team in evaluating and treating this condition. Objectives: Identify appropriate candidates for bipedicled TRAM flaps. Summarize the risks that are associated with post-operative flap complications. Outline the key steps regarding flap elevation and inset. Explain the importance of collaboration and communication among the interprofessional team to ensure the appropriate selection of candidates for bipedicled TRAM flap and to enhance postoperative management. Access free multiple choice questions on this topic.

Breast cancer affects 1/7 women in the U.S., making it the most common malignancy in women.[1] Despite the equivalence of breast-conserving surgery and mastectomy, 34% of women opt for mastectomy for a variety of reasons.[2] Breast reconstruction is a continually evolving entity that ranges in complexity from the use of prostheses to autogenous tissue. While alloplastic reconstruction remains the most popular option, the use of autogenous tissue has been shown to create a more natural breast, which ultimately requires less subsequent surgical intervention and provides the highest patient satisfaction.[3] In the realm of autogenous breast reconstruction, the most commonly used flaps are abdominally based (the muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM), superficial inferior epigastric artery (SIEA), and deep inferior epigastric perforator (DIEP) flaps.[4] However, the differences regarding safety, factors contributing to complications, and overall patient desires, requires that these decisions be highly individualized.

Complications related to a bipedicled TRAM have been cited as Potential abdominal wall morbidity, including hernias, bulging, and a decreased ability to perform certain physical activities Possibility of partial/total flap loss Infection Hematoma Fat necrosis

Abdominal based flaps have become the workhorses for autologous breast reconstruction. Options include free bipedicled TRAM, MS-TRAM, DIEP, and SIEA flaps. The decision regarding which approach to use should be individualized to the patient’s needs and history. It is crucial to educate the patient regarding the potential complications and provide them with a complete list of options available. To achieve the best overall outcome, it is essential to have a multidisciplinary approach consisting of the plastic surgeon, breast surgeon, oncologist, anesthesiologist, pharmacists, and nursing staff. Intraoperative and postoperative care is of critical importance to ensure the success of the flap. Communication with operative staff and anesthesia will create the most favorable environment. Nursing staff in the postoperative period are often the first to notice any flap issues, and they require appropriate training in regards to what to look for and how to recognize potential flap compromise. A cohesive, multidisciplinary team is necessary to prevent complications and to diagnose and effectively treat any flap issues promptly.