1 Scientific RepoRts | 6:29580 | DOI: 10.1038/srep29580 www.nature.com/scientificreports Breast reconstruction with single- pedicle TRAM fap in breast cancer patients with low midline abdominal scar Jun-Dong Wu 1 , Wen-He Huang 1 , si-Qi Qiu 1 , Li-Fang He 1 , Cui-ping Guo 1 , Yong-Qu Zhang 1 , Fan Zhang 2 & Guo-Jun Zhang 1,2 Breast reconstruction with transverse rectus abdominis myocutaneous (TRAM) fap is challenging in patients with low midline abdominal scar. In this study, we aimed to investigate the clinical feasibility of immediate breast reconstruction using single-pedicle TRAM (SP-TRAM) faps in patients with low midline abdominal scar. There were 4 strict selection criteria: 1) presence at least 3 perforators on the pedicle side; 2) perforators with regional average fow velocity of >20 cm/s; 3) upper edge of the abdominal scar at least 4 cm from the umbilicus; and 4) scar age >1 year. Eight breast cancer patients with low midline abdominal scar (scar group) and 20 without (control group) underwent immediate breast reconstruction with SP-TRAM faps consisting of zone I and III and zone II tissues. Flap complications, donor-site complications, and cosmetic results were compared between the two groups. All faps survived and both groups presented similar fap and donor site complications, including fat necrosis, seroma, hematoma, infection, delayed wound healing, and abdominal hernia, and patients in both groups had similar aesthetic results (p > 0.05). Thus, the study demonstrated that breast reconstruction using SP-TRAM fap was a safe approach in carefully selected patients with low midline abdominal scar. Transverse rectus abdominis myocutaneous (TRAM) fap and its variations are considered the best available options for autologous breast reconstruction afer mastectomy 1–4 . Abdominal scars from previous surgeries ofen present a challenge when TRAM fap is desired for breast reconstruction 1,2,5–8 . In patients with low midline abdominal scars, for instance, tissue perfusion across the midline scar is unreliable, which may lead to fap necro- sis, fat necrosis, or wound breakdown at the donor site 2,5,7 . Nonetheless, TRAM faps can still be appropriate for breast reconstruction even in the presence of a low midline abdominal scar 9 . Various operative strategies have been suggested to improve fap survival and reduce donor-site complications in these patients. A hemi-TRAM fap can be used safely in patients with low midline abdominal scar 5,9,10 , but it will limit the volume of the reconstructed breast 1,2,5,10 . Tus, other techniques, includ- ing double-pedicle or free TRAM faps and deep inferior epigastric perforator (DIEP) faps, which can augment tissue perfusion across midline scars, have also been proposed 5,10 . However, all of these methods are complex and tedious, and furthermore, the use of complicated microsurgical techniques may not be practical in all clinical situations 2,5 . In this study, we performed breast reconstruction using single-pedicle TRAM (SP-TRAM) faps in selected patients with low midline abdominal scar. In order to guarantee sufcient fap volume at the donor site, the loca- tions and peak systolic fow velocities of the perforators were determined by preoperative color-fow duplex scan- ning for each patient. We compared the outcomes of SP-TRAM breast reconstruction in patients with or without low midline abdominal scar in 8 (scar group) and 20 (control group) patients, respectively, and this small series demonstrated the safety and feasibility of SP-TRAM faps in patients with low midline abdominal scar. 1 The Breast Center, Cancer Hospital of Shantou University Medical College, 7 Raoping Rd. Shantou 515041, Guangdong, China. 2 changjiang Scholar’s Laboratory, cancer Hospital of Shantou University Medical college, Guangdong, China. Correspondence and requests for materials should be addressed to G.-J.Z. (email: guoj_zhang@ yahoo.com) Received: 29 March 2016 accepted: 20 June 2016 Published: 13 July 2016 OPEN