TRAM flap breast reconstruction with expanders and implants.

Breast reconstruction has become an essential part of breast cancer management. The transverse rectus abdominis myocutaneous (TRAM) flap has replaced the prosthetic implant as the first choice for breast reconstruction. There are several incidences in which the volume of autogenous tissue cannot fulfill the requirements for symmetric reconstruction, especially in those patients with limited abdominal tissue and large ptotic breasts. The TRAM flap can be combined with tissue expanders and implants to obtain symmetry in these difficult reconstructive situations.