Microsurgical Free Flap Technique  Just as with the standard TRAM flap, this technique uses a similar skin and fat ellipse from the lower abdomen transferred to the chest wall and shaped into a breast mound. The free flap technique, however, requires only a small portion of the rectus muscle, which contains the major blood vessels responsible for nourishing the flap.
    When the free flap is transferred to the chest wall, the divided blood vessel ends are joined directly to an appropriate chest wall artery and vein by microsurgical technique. This eliminates the need for the full length of rectus muscle (which surrounds the nourishing vessels) to be twisted and turned upward as the flap is repositioned onto the chest wall.
Patients who have had their abdominal muscles cut during previous surgery (a gall bladder operation, for example) would not be acceptable candidates for a standard TRAM flap, but a free TRAM flap could be safely used in such cases.
    With either technique, it is imperative that any smoking stop completely for one month before and after surgery.