Current Role of Pedicled Transverse Rectus Abdominis Myocutaneous Flap in Breast Reconstruction - Review and Case Reports

Sep 29, 2026

Pedicled transverse rectus abdominis myocutaneous (pTRAM) flap remains a key option for breast reconstruction despite increasing use of muscle-sparing alternatives. A systematic review with PubMed searches (2014–2024) plus two institutional case reports evaluates current indications, outcomes, and clinical utility. Findings highlight shorter operative times, independence from microvascular techniques, and versatility for complex settings, especially when microsurgery is not feasible, with generally high aesthetic outcomes and low major complication rates.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Background

Methods

Results

Conclusions

Introduction

Case 1

Case 2

Original article Breast Current Role of Pedicled Transverse Rectus Abdominis Myocutaneous Flap in Breast Reconstruction: Review and Case Reports Domenico Mariniello, MD* Santolo D’Antonio, MD† Francesco Castellaneta, MD* Michele Pio Grieco, MD* Tommaso Fabrizio, MD* Background: The pedicled transverse rectus abdominis myocutaneous (pTRAM) flap has long been a cornerstone in breast reconstruction. Despite the increasing adoption of muscle-sparing options such as the deep inferior epigasetric perforator flap, the pTRAM remains relevant, particularly in resource-limited settings orin patients unsuitable for microsurgery. This systematic review aimed to evaluate its current indications, outcomes, and clinical utility. Methods: Following Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines, a literature search of PubMed was conducted using the terms“pedicled TRAM flap” and “breast reconstruction,” covering studies published from 2014 to 2024. A total of 43 articles, including original studies and case reports, met the inclusion criteria. Additionally, 2 clinical cases from our institution werepresented to illustrate contemporary applications. Results: The pTRAM flap offers several advantages: shorter operative times, independence from microvascular techniques, and versatility in complex reconstructive scenarios. It is especially suitable for patients with prior radiation therapy, vessel-depleted fields, or contraindications to free flap surgery. Although donorsite complications such as abdominal bulging and hernias remain concerns, outcomes have improved with mesh reinforcement and vascular delay techniques. Across included studies, aesthetic outcomes and patient satisfaction were high, and major complications were uncommon. Conclusions: The pTRAM flap remains a reliable and accessible choice for breast reconstruction, particularly in patients or settings where microsurgery is not feasible. Although deep inferior epigasetric perforator flaps provide superior muscle preservation, the pTRAM combines speed, safety, and predictable results, maintaining a significant role in modern reconstructive practice. Mastery of this technique facilitates the transition to advanced microsurgical procedures. (Plast Reconstr Surg Glob Open 2026;14:e7053; doi: 10.1097/GOX.0000000000007053; Published online 6 January 2026.) INTRODUCTION Until 1982, the only option for autologous breast reconstruction was the latissimus dorsi flap.1 That year, Hartrampf et al2 introduced the transverse rectus abdominis myocutaneous (TRAM) flap for the From the *Division of Plastic Surgery, IRCCS Centro di riferimento Oncologico della Basilicata, Rionero in Vulture, Potenza, Italy; and †Division of Plastic Surgery, AOU Federico II, Naples, Italy. Received for publication January 27, 2025; accepted June 10, 2025. Copyright © 2026 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. DOI: 10. 1097/GOX.0000000000007053 first time. Compared with the latissimus dorsi flap, the pedicled transverse rectus abdominis myocutaneous (pTRAM) flap offers a significantly greater amount of tissue.3 However, the dissection required for TRAM flaps can lead to significant muscle deficits, hernias, and abdominal bulging.3,4 The considerable morbidity of the donor site in the abdominal wall has driven the search for microvascular techniques that preserve muscle, such as the muscle-sparing free TRAM flap and the deep inferior epigastric perforator (DIEP) flap, making the pTRAM flap less popular over time.4 However, [www.PRSGlobalOpen.com](www.PRSGlobalOpen.com)

FAQs

What is the purpose of this review on the pTRAM flap in breast reconstruction?

To evaluate pTRAM flap indications, outcomes, and clinical utility based on literature from 2014 to 2024 and to present contemporary applications through institutional cases.

Which patient settings make the pTRAM flap particularly suitable?

It is especially suitable for patients with prior radiation therapy, vessel-depleted fields, or contraindications to free flap surgery.

What are the main advantages and limitations of the pTRAM flap reported in the document?

Advantages include shorter operative times, independence from microvascular techniques, and versatility; limitations include donor-site concerns such as abdominal bulging and hernias, with improved outcomes described using mesh reinforcement and vascular delay techniques.

Sep 29, 2026

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