Prosthetic breast reconstruction began in the early 1960s and prevailed in the 1980s. The operation method is simple and suitable for patients with good local soft tissue coverage and unwilling to lose autologous tissue in other parts of the body. The method is to place the prosthesis filled with silica gel, silica gel or normal saline under the skin flap or pectoralis major muscle after mastectomy. If the local tissue can't provide enough cavity to accommodate the prosthesis after mastectomy, a skin dilator can be placed first, and water can be injected regularly after mastectomy. After a sufficient cavity is formed, the dilator can be replaced with a breast prosthesis.
Breast reconstruction with autologous tissue transplantation has the advantages of naturalness, durability and good aesthetic effect. The most commonly used are various lower abdominal flaps and latissimus dorsi myocutaneous flaps. Others, such as gluteus maximus myocutaneous flap, anterolateral thigh flap, gracilis transverse myocutaneous flap and tensor fascia lata myocutaneous flap, have been used in breast reconstruction to some extent, but the application has been less.
The traditional pedicled rectus abdominis myocutaneous flap was first proposed by Hartampf in 1982. It can be pedicled with unilateral rectus abdominis or bilateral rectus abdominis. The transverse rectus abdominis myocutaneous flap has a large amount of tissue, reliable blood supply and plastic effect on abdominal wall, which is especially suitable for middle-aged patients with abdominal distension. The blood supply of the flap depends on the superior epigastric artery and vein in rectus abdominis. The blood of the superior epigastric artery reaches the inferior epigastric artery through spiral artery anastomosis, and then the flap is supplied by the perforating branch of the inferior epigastric artery. Breast reconstruction with single pedicle TRAM flap is prone to blood supply disorder of some flaps. Due to the loss of rectus abdominis, the abdominal wall may be very fragile, which may lead to abdominal hernia. Artificial patch is needed to repair the defect area during operation, which may also cause certain abdominal wall dysfunction. The use of double pedicle TRAM flap makes the blood supply of the flap more reliable. Excision of bilateral rectus abdominis will also increase the chance of abdominal wall complications.