Shaping the Breast Mounds in Bilateral TRAM Flap Breast Reconstruction

Summary

Shaping the breast in bilateral reconstruction is similar to shaping the unilaterally reconstructed breast, except that an existing breast need not be matched. In most cases, symmetry is easier to achieve in bilateral reconstruction, and the aesthetic results are better. The actual shaping techniques are the same as those described for unilateral reconstruction (chapters 16 and 17), except that in delayed bilateral reconstruction the level of the inframammary folds is determined by the surgeon. Also, the size of the breasts that can be created may be limited if the patient is thin. Shaping of the breasts occurs near the end of the reconstruction, when surgeons are fatigued and eager to finish the operation. Nevertheless, if a reasonable effort is made, the results can be truly outstanding.