A New Concept of Interval TRAM for Immediate Breast Reconstruction in Obese Women

  • Ashraf KhaterEmail author
  • EmadEldeen Hamed
  • Sameh Roshdy
  • Waleed Elnahas
  • Omar Farouk
  • Ahmed Senbel
  • Adel Fathi
  • Osama Eldamshety
  • Ahmed Abdallah
Original Article


Performing pedicled TRAM in obese women carries risk of flap loss or native breast envelop necrosis. Our technique depends on performing total flap delay at the same setting with mastectomy with flap suture in situ to be followed 1 week later by flap transfer. This study included 24 operable women who were candidates for skin sparing or modified radical mastectomy. In one case, delay was only done and followed by mastectomy and flap transfer. In later experience, delay plus mastectomy was done first and followed later by flap transfer. Operative data and postoperative complications were recorded. The mean BMI was 37 ± 2.75. The mean total operative time was 200 ± 20.37. The mean total hospital stay was 9.1 ± 3.35 days. The mean total volume of blood loss was 380 ± 82.33 ml. Breast envelop necrosis was encountered in four cases; three of them were replaced by the TRAM skin. There was no total flap loss while partial loss was recorded in five cases. Fat necrosis occurred in eight cases. Most of mastectomy bed and abdominal complications were in average. Most of cases showed satisfactory esthetic outcome. Our new concept of “Interval TRAM” enables safe immediate breast reconstruction with pedicled TRAM in obese women and ensures presence of a skin pack up for the native breast envelop skin. We recommend this technique in every obese female who undergoes skin sparing mastectomy with immediate pedicled TRAM flap reconstruction.


Mastectomy Reconstruction TRAM flap Interval Obese 


Author Contributions

Study concept and design: Ashraf Khater.

Acquisition of data: EmadEldeen Hamed.

Analysis and interpretation: Sameh Roshdy, Waleed Elnahas,,Omar Farouk, Ahmed Senbel, Adel Fathi, and Osama Eldamshety.

Study supervision: Ashraf Khater and Ahmed Abdallah.

Compliance with Ethical Standards

All patients were consented with a written consent after the explanation of the procedure and approval by the local institutional ethical committee.

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Indian Association of Surgical Oncology 2019

Authors and Affiliations

  • Ashraf Khater
    • 1
    Email author
  • EmadEldeen Hamed
    • 1
  • Sameh Roshdy
    • 1
  • Waleed Elnahas
    • 1
  • Omar Farouk
    • 1
  • Ahmed Senbel
    • 1
  • Adel Fathi
    • 1
  • Osama Eldamshety
    • 1
  • Ahmed Abdallah
    • 1
  1. 1.Department of Surgical Oncology, Mansoura Oncology center (OCMU), Faculty of MedicineMansoura University, EgyptMansouraEgypt

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