The pedicled TRAM flap based on superior epigastric artery is very safe and reliable flap which provides sufficient autologous tissue for natural breast reconstruction. Depending on quantity of abdominal tissue used for the reconstruction, the breast can be sufficiently large and ptotic to achieve symmetry in a single operative procedure. The importance of appropriate patient selection should never be underestimated, especially in risky patients like heavy smokers, those with previous vascular diseases or heavy scarring of the abdominal wall, where delayed procedure is strongly indicated. Adequate patient selection, preoperative management, monitoring of the flap and routine postoperative care with oxygenation, together with the selection of proven surgical technique is the key for the safety of the procedure and reduced patient morbidity.

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