Mammographic appearance of the transverse rectus abdominus musculocutaneous (TRAM) flap

The mammograms of 10 patients who had undergone a total of 11 breast reconstructions using the transverse rectus abdominis muscle (TRAM) flap procedure were reviewed. A variety of mammographic findings was observed, including areas of increased density, microcalcifications, and lucent masses. Three lesions were biopsied, and all showed fat necrosis. The mammographic findings often appeared many months after surgery. Some of the changes increased over time, and others decreased spontaneously on serial mammography. Fat necrosis, which can sometimes mimic malignancy on mammography, was a relatively common occurrence in breasts reconstructed with the TRAM flap procedure. More recent modifications of the TRAM flap should reduce the incidence of fat necrosis.