From 1/98 to 12/02 the senior author has performed 216 pedicled TRAM flaps for autogenous breast reconstructions in 177 consecutive patients. The reconstructions have been single pedicle and double pedicle for unilateral reconstructions. We have also performed bilateral reconstructions with single pedicle TRAM flaps. We have developed and refined indications for performing double pedicle TRAM as well as when to perform bilateral reconstruction.

In our experience with 138 unilateral breast reconstruction we used the single pedicle in 101/138 (73 %) and double pedicle in 37/138 (27 %). Bilateral breast reconstructions were performed in 39 patients (22 %). In 54 % (20/37) of the double pedicle and 52 % (20/39) of the bilateral tram reconstructions, prolene mesh was placed in the abdominal wall. The reasons for performing breast reconstruction were as follows 69 % for invasive cancer, 18 % for carcinoma in situ, 6 % for high risk, and 4 % for recurrence.

We will discuss our technique, results, complications with specific attention to adjuvant therapy, maintenance of normothermia during the operative procedure, and finally total number of procedures for completion of breast reconstruction.