Are there any managed care issues peculiar to TRAM flaps?
Yes. In some parts of the country surgeons are performing fewer TRAM flaps because the reimbursement from managed care plans does not justify the time and level of expertise involved. TRAM flaps, particularly free TRAM flaps, proceed far more expeditiously (allowing for less time under anesthesia and lower operative risk) when two or more qualified plastic surgeons or plastic surgical teams are working together. Managed care plans are increasingly reluctant to provide coverage for these additional personnel; consequently, coverage should be carefully considered before undergoing TRAM flap reconstruction. In our experience, liposuction is often requested by the patient to help improve the contour of the abdomen following TRAM flap reconstruction, but managed care plans are reluctant to provide coverage for the liposuction.
