Postmastectomy reconstruction of breasts is one of the most commonly performed procedures of the plastic surgeon today. Tissue expansion with subsequent implant placement, transverse rectus abdominis musculocutaneous (TRAM) flaps, latissimus dorsi flaps, gluteal flaps, Ruben's fat pad flaps, and free flaps from other areas have all been utilized with consistently good aesthetic results. One special class of patient is the woman who has undergone breast reconstruction with tissue expansion, with or without subsequent implant placement, who than receives external beam radiation therapy. Capsular contraction frequently complicates this therapy. In the past, women have undergone capsulotomy or capsulectomy with replacement of the implant. Recently, women are more reluctant to have foreign tissue in their bodies and are opting for autologous tissue reconstructions. TRAM reconstruction following removal of implants has been previously reported. A new approach to the placement of the TRAM flap after implant reconstruction via the abdominal approach, with avoidance of any incision on the breast itself, is presented. This is especially important in a patient who has evidence of radiation damage to the skin, placing any incision through the treated tissue at risk.
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