Abstract

Body contour surgery concerns the correction of diverse morphological abnormalities of the body which may occur due to various acquired and congenital etiologies. The concept of surgical body sculpting has achieved widespread recognition and acceptance because it safely alters such deformities yielding functionally aesthetic results. Several factors account for the current popularity of body contouring. Foremost among them, is the considerably increased exposure of the body which is seen in most modem cultures, particularly in warm climates. In no other period the history of western civilization have men and women been so revealingly attired. In addition, today's competitive society strongly encourages the maintenance of a lean athletic body, as a symbol of good health, youth and vigor. The reality of achieving this physical ideal becomes increasingly less likely because of current sedentary lifestyles and dietary excesses. These factors combine to create a disturbing disequilibrium between an individual's desired condition and his actual state. Regular adherence to proper diet and exercise must be stressed, but unfortunately some of these deformities remain resistant to the most sincere of such efforts. Subsequently, there are increasingly greater numbers of people who seek surgical correction for specific abnormalities. Body contour surgery is also an important reconstructive tool in the correction of extremely lax skin in obese patients who have recently undergone dramatic weight loss.

Abstract

The type of reconstruction performed following skin tumor surgery is directly related to the type, extent, and site of the skin tumor. The skin tumors with which the plastic surgeon is most often confronted are the basal and squamous cell cancers and melanoma. It is well documented that the incidence of these tumors are increasing at an alarming rate. This is believed to be primarily due to excessive sun exposure and the thinning of the protective ozone layer. Under these circumstances, the plastic surgeon today must be well equipped to not only treat these tumors, as well as other rarer diseases, but also to reconstruct the sometimes challenging resulting defects. The guiding reconstructive principle is as Ralph Millard admonished: Replace lost tissue with like tissue. A skin graft at the tip of the nose can be very distracting due to its patch-like, depressed appearance. In contrast, a full-thickness skin flap would allow the reconstructive "material" to blend in with its surroundings for a more impressive result. The plastic surgeon has several items in his armamentarium to assist in the execution of this principle. Some of the techniques are based on age-old ideas, while others represent very recent, almost revolutionary advances. These advances include: 1. The introduction of the tissue expander: This concept has allowed the plastic surgeon to reconstruct defects that would would have normally required disfiguring skin grafts or free tissue transfers. 2. The elucidation of the vascular supply to the skin and underlying muscles and fascia: This knowledge has endowed the plastic surgeon with a tremendous pallet of reliable flaps to reconstruct a particular defect.

Abstract

The transverse rectus abdominus musculocutaneous flap, or tram flap, has revolutionized the plastic and reconstructive surgeon's approach to breast reconstruction. Since its first clinical description by Hartrampf, Scheflan, and Black in 1982, the TRAM flap has become today's standard for autogenous tissue breast reconstruction. In light of the recent controversy regarding silicone breast implants, the use of autogenous tissue for breast reconstruction has become even more popular. It is the wide belief of most plastic and reconstructive surgeons that, by using autogenous tissue, the reconstructed breast has a more natural shape and contour. Furthermore, patient satisfaction is extremely high and problems inherent with implants, such as capsular contracture, are avoided. With newer technology and a stronger emphasis on self-examination and routine mammographic screening, breast cancer is currently being detected at earlier stages. Because of this, more and more women with diagnosed breast cancer are undergoing breast conserving surgery and radiotherapy. Patients with larger tumors, in more advanced stages, often require a more extensive operation, namely a modified radical mastectomy. The TRAM flap, in an immediate or delayed setting, is an ideal technique for the reconstruction of a modified radical mastectomy defect. We at the Breast Care Center of Mount Zion Medical Center of U.C. San Francisco are extremely pleased with the results of immediate breast reconstruction using the TRAM flap techniques.