Determining the Trimming Layer in Breast Reconstruction with a Free TRAM Flap Using Intraoperative Video-angiography

In breast reconstruction using a free transverse rectus abdominis myocutaneous or deep inferior epigastric perforator flap, the trimming process for the flap area, which is usually the upper portion of the reconstructed breast, is critical to creating a natural-looking breast. In this study, we investigated which subcutaneous fat layer of the abdominal flap benefited most from a well-maintained blood supply during the trimming process using intraoperative fluorescent angiography system in a cross-sectional view of the elevated abdominal flap. We concluded that, for cosmetic purposes, the deep subcutaneous fat layer (beneath Scarpa’s fascia) should be trimmed first to minimize fat necrosis due to fat ischemia.