The Rotated Bipedicled Tram Flap: Maximising Breast Projection but Minimising Donor Morbidity - A Case Report

Norlia Abdullah, Saiyidah Adila Mohd Adibi, Nur Fa'izah Ab Muin, Nordashima Abd Shukor, Suria Hayati Md Pauzi

Abstract


Autologous breast reconstruction using the transverse rectus abdominis myocutaneous (TRAM) flap remains a cornerstone of breast reconstructive surgery. However, with the classical TRAM flap, it is challenging to close a large post mastectomy defect in nulliparous and/or slim women. The resultant reconstructed breast also lacks projection. This case reported a novel modified TRAM flap technique performed in a nullipara. She had previously undergone a hysterectomy and oophorectomy for endometrial carcinoma via a pfannenstiel incision. She presented with a large left breast invasive micropapillary carcinoma (ER/PR negative HER2 3+) with only marginal response to neoadjuvant chemotherapy. She underwent a left mastectomy with axillary dissection and immediate breast reconstruction. The rotated bipedicled TRAM Flap was used to close the large defect, maximising breast projection while minimising donor site morbidity.


Keywords


Donor; invasive micropapillary breast carcinoma; morbidity; nullipara; projection; reconstruction; rotated; TRAM flap; site

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References


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DOI: http://dx.doi.org/10.17576/JSA.2026.1601.05

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