A 53-year-old woman underwent prophylactic bilateral subcutaneous (total) mastectomies with submuscular silicone implants in her 30's because of a strong family history of breast cancer. She developed problems with leakage and capsule formation and was scheduled for implant removal and bilateral transverse rectus abdominis musculocutaneous flap (TRAM) reconstruction. The skin markings are shown. The flap is based on perforators of the superior/inferior epigastric vessels traversing the rectus abdominis muscles (see TRAM breast reconstruction)
The left corner of the flap was elevated off the deep abdominal fascia up to the edge of the rectus sheath. The rectus sheath was incised at its lateral border and above and below the composite island.
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