The internal oblique repair of abdominal bulges secondary to TRAM flap breast reconstruction.

The internal oblique repair, a new method for repair of abdominal bulging following TRAM flap breast reconstruction, involves identification and repair of the internal oblique fascia. To assess the usefulness of this repair and to compare it with simple plication of the deep abdominal fascia, we retrospectively reviewed all abdominal bulge repairs performed by the first author over the past 7 1/2 years. Of 30 abdominal bulge repairs, the internal oblique repair was used in 14 patients and plication in 16 others. The bulge recurrence rate was lower after the internal oblique repair (21 percent) than after the plication repair (69 percent; p = 0.028). When synthetic mesh reinforcement was added to the internal oblique repair, the bulge recurrence rate dropped to 13 percent. We conclude that the internal oblique repair is the preferred technique for the correction of abdominal bulges secondary to TRAM flap breast reconstruction.