Free TRAM flap reconstruction after skin sparing mastectomy

The free TRAM (transverse rectus abdominis myocutaneous) flap completely detaches and directly transfers the lower abdominal tissue to the mastectomy site. The deep inferior epigastric artery and vein, which provide the vascular supply for the free flap, are anastomosed to local recipient vessels, using either the internal mammary or thoracodorsal arteries and veins. This can be performed to provide immediate or delayed breast reconstruction. In this drawing, a skin sparing mastectomy is depicted. This drawing depicts the blood supply anastomosis to the thoracodorsal vessels; however, the internal mammary site is also used commonly for the site of anastomosis.