Breast reconstruction with TRAM flaps: normal and abnormal appearances at CT.

In the transverse rectus abdominis musculocutaneous (TRAM) flap procedure, a portion of the abdominal wall is transposed to the chest as a pedicle or free flap. Patients who have undergone this procedure often subsequently undergo computed tomography (CT) for assessment of metastatic disease or unrelated pathologic conditions. CT scans obtained in patients who had undergone the TRAM flap procedure were reviewed to facilitate recognition of both the normal and abnormal postoperative CT appearances of the TRAM flap. In 28 reconstructed breasts in 21 patients, three general appearances were identified: type 1 (homogeneous fat attenuation) (n = 4), type 2 (fat attenuation with a thin, curvilinear soft-tissue band parallel to the skin surface) (n = 19), and type 3 (thick soft-tissue band parallel to the skin surface) (n = 5). A mass that arose in a type 2 breast 21 months after surgery represented recurrent cancer. A markedly thickened soft-tissue band in another patient represented a dry eschar with inflammation and fat necrosis. The rectus abdominis muscle was partially absent in eight cases and completely absent in 20 cases. Recognition of the normal postoperative appearance of the body wall helps avoid confusion with disease states and allows identification of abnormal conditions such as inflammation, infection, and recurrent breast cancer.