Is pregnancy contraindicated following free TRAM breast reconstruction?

There are reports of patients having normal full term pregnancies following pedicled transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. These are individual cases and there is only limited published evidence to support the safety of pregnancy following surgery of this nature. Little is known about the effects of pregnancy after free tissue transfer, therefore it has been difficult to advise patients, in this situation, what the recommended course of action should be. A report of pregnancy following free TRAM flap breast reconstruction is presented with a review of relevant literature in an attempt to clarify this issue and improve the consent process. We conclude that TRAM flap breast reconstruction is not an obstacle to normal pregnancy and delivery. Patients need to be guided through the potential risks to their health if they should become pregnant, before reconstruction takes place. Obstetric and Oncological Specialists, as part of the multi-disciplinary setting, need to be involved early in pregnancy to further inform and counsel these patients. (C) 2006 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved.