title: Minimizing donor-site morbidity following bilateral pedicled TRAM breast reconstruction with the double mesh fold over technique.
abstract: BACKGROUND
  Transverse rectus abdominus muscle flaps (TRAM) can result in significant abdominal wall donor-site morbidity. We present our experience with bilateral pedicle TRAM breast reconstruction using a double-layered polypropylene mesh fold over technique to repair the rectus fascia.
  
  
  METHODS
  A retrospective study was performed that included patients with bilateral pedicle TRAM breast reconstruction and abdominal reconstruction using a double-layered polypropylene mesh fold over technique.
  
  
  RESULTS
  Thirty-five patients met the study criteria with a mean age of 49 years old and mean follow-up of 7.4 years. There were no instances of abdominal hernia and only 2 cases (5.7%) of abdominal bulge. Other abdominal complications included partial umbilical necrosis (14.3%), seroma (11.4%), partial wound dehiscence (8.6%), abdominal weakness (5.7%), abdominal laxity (2.9%), and hematoma (2.9%).
  
  
  CONCLUSIONS
  The TRAM flap is a reliable option for bilateral autologous breast reconstruction. Using the double mesh repair of the abdominal wall can reduce instances of an abdominal bulge and hernia.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Quillen College of Medicine at East Tennessee State University, Johnson City, TN, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Bharti
authors.forename: Leslie
authors.initials: L
authors.lastname: Groves
authors.forename: Claire
authors.initials: C
authors.lastname: Sanger
authors.forename: James
authors.initials: J
authors.lastname: Thompson
authors.forename: Lisa
authors.initials: L
authors.lastname: David
authors.forename: Malcolm
authors.initials: M
authors.lastname: Marks
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D017568:Rectus Abdominis / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013526:Surgical Mesh