For women who are candidates for breast reconstruction using their own (autogenous) tissue, the pedicled TRAM (transverse rectus abdominus myocutaneous) flap is a common technique. Unfortunately, many patients undergoing pedicled TRAM flap breast reconstruction develop abdominal wall weakness, bulging and hernia because their rectus muscle has been sacrificed as part of the flap. For this reason, the surgeons at NYBRA/Aesthetic Plastic Surgery, PC do not use the pedicled TRAM in their practice. Instead, they are able to minimize the risk of hernias by using the most advanced microsurgical breast reconstruction techniques that preserve the rectus muscles – like DIEP, SIEA, and muscle-sparing TRAM free flap procedures. While the risk remains low, some patients undergoing these muscle-sparing microsurgical procedures may also develop abdominal wall bulging.
Over the past decade, Dr. Ron Israeli has developed and refined a unique and reliable technique for repair of TRAM hernias and bulges. This specialized TRAM bulge repair and abdominal wall reconstruction technique was developed in collaboration with Dr. George DeNoto, Director of General Surgery at St. Francis Hospital (Roslyn, N.Y.). In this procedure, an extended onlay mesh repair is completed along with fascial plication and external oblique muscle reinforcement.
Recently updated and improved, this technique for abdominal wall reconstruction in patients with TRAM and DIEP flap-related hernias was selected for presentation at the Abdominal Wall Reconstruction (AWR) meeting in Washington, DC. The AWR meeting is the leading annual conference focusing on an interdisciplinary approach to the management of complicated abdominal wall hernias. Hundreds of plastic surgeons and general surgeons gather at the AWR meeting to discuss the most current cutting edge techniques.
In addition to their presentation, Drs. Israeli and DeNoto have also written a book chapter titled "Repair of the Post-TRAM Bulge/Hernia" for the second edition of the Atlas of Abdominal Wall Reconstruction released last month. While there have been other published approaches to repairing TRAM bulges with varying degrees of success, the technique described by Dr. Israeli and Dr. DeNoto in their book chapter is among the most effective and reliable approaches available.
Contact our office for more information about this unique and reliable approach to TRAM hernia repair.
Photo: Ron Israeli, MD and George DeNoto, MD at the 2016 AWR meeting