Fig. 1

A schematic of the selective salvage of zones 2 and 4 in the unipedicled transverse rectus abdominis musculocutaneous (TRAM) flap. a The distal area of zone 4 is discarded. b The proximal area of zone 4 is formed into a vascularized dermis graft to enhance the peripheral contour of the upper pole and to prevent fat necrosis. c The middle area of the distal 80 % of zone 2 is formed into a dermo-adipofascial flap, which includes the dermis and thick superficial fat layer (with Scarpa’s fascia). d, e The upper and lower areas of the distal 80 % of zone 2 are formed into a dermofat flap, which includes the dermis and thin superficial fat layer. In this manner, by selective salvage of zones 2 and 4, TRAM flap fills the volume more naturally at the upper pole of the breast skin envelope, and prevents fat necrosis by focusing on the deep fat layer