The "aesthetic subunit" principle in late TRAM flap breast reconstruction.

The "aesthetic subunit" principle is well established in facial reconstruction. This principle dictates that the margins of regional reconstructions correspond to existing visual boundaries. This will minimize the visual perception of "abnormal." The subunit principle also applies to secondary TRAM flap breast reconstructions in which the available chest wall skin is of poor quality. In these situations, it might be aesthetically advantageous to replace poor quality chest wall skin with a TRAM flap skin paddle that ends at the inframammary fold.