chapter  13
Other free flaps in breast reconstruction
ByBrian A. Mailey, Gregory R. D. Evans
Pages 15

Breast reconstruction using autologous free fl aps is widely practiced in the United States. The lower abdominal tissue provides the most common donor site for this type of reconstruction with the prototype being the free transverse rectus abdominus muscle (TRAM) fl ap ( 1,2 ). Advantages to the well-established TRAM include reliable anatomy, ample tissue for re-creating the breast mound and versatility of reconstruction options (e.g., pedicled vs. free). However, the TRAM compromises abdominal wall structure and has been associated with abdominal bulging and hernias ( 3 ). In an effort to reduce this donor-site morbidity, a movement from free TRAM to muscle-sparing TRAM and deep inferior epigastric perforator (DIEP) fl aps has occurred ( 3 ). Additional investigations of free microvascular tissue transfer revealed techniques to avoid compromising abdominal structure ( 4 ), as well as alternative donor sites when lower abdominal tissue is unavailable. These autologous options include transfer of back tissue ( 5,6 ), buttock tissue ( 7,8 ) and thigh tissue ( 9-11 ).