To explore the application of the new periumbilical button-shaped incision in breast reconstruction with transverse rectus abdominis musculocutaneous (TRAM) flap.

Nipple-sparing mastectomy combined with breast reconstruction with TRAM flaps harvested via an button-shaped incision was performed in two breast cancer patients in the First Affiliated Hospital of Army Medical University in March and April 2023. The operative steps included performing nipple-sparing mastectomy, making a button incision, separating subcutaneous tissues and harvesting the lateral rectus abdominis muscle flap, de-epithelializing circumferential skin, transferring abdominal skin flap for shaping and suturing, and purse-string suturing for abdominal incision. Postoperative cosmetic results of the abdomen and the breast were assessed monthly.

The surgery was successfully accomplished in the two cases. The operation time was 446 min and 299 min, respectively. Intraoperative blood loss was 100 ml in both cases. There was no postoperative infection or hematoma in the area of abdominal incision. No ischemia or necrosis of the reconstructed flap in the breast occurred. The results at 1.5 and 3 months follow-ups showed a significantly smaller and more occult abdominal scar compared with other patients receiving conventional surgery.

Button-shaped incision for harvesting TRAM flap is a feasible technique for breast reconstruction, with the advantages of small trauma and concealed postoperative scars.