the bipedicle (full thickness vertical dermal flap) breast reduction, or mckissock reduction mammaplasty, has long been a standard to which other operative methods of breast reduction have been compared. Paul kendrick mckissock, a california plastic surgeon, published his procedure in the march 1972 issue of plastic and reconstructive surgery. A retrospective review was performed over a 2-y period of bipedicle-conjoined abdominal perforator flaps in 28 patients. For each reconstruction, the pedicle of one flap was anastomosed to the anterograde internal mammary artery vessels and the pedicle of the second flap to a side branch of the primary flap or the retrograde internal mammary vessels. Bipedicle-conjoined abdominal perforator flaps represent a novel technique in select patients seeking breast reconstruction. The added complexity was safe and reliable in this series of patients. The upper half of the bipedicle flap was freed from the pectoral fascia after a central wedge of breast tissue was excised. The lateral and medial breast flaps were thinned and feathered. Request pdf on aug 2, 2019, ankur khajuria and others published outcome reporting in breast reconstruction find, read and cite all the research you need on researchgate. 1055b-0040-176817 51 transverse rectus abdominis musculocutaneous flapsglyn e. Jones summary this chapter describes the unipedicle transverse rectus abdominis musculocutaneous flap and its use in breast reconstruction. The indications for and technique of performing the flap are discussed in detail, outlining important technical tips, which may help with overall success. Shestak overview this chapter was written for the first edition of surgery of the breast principles and art. It accurately reflected my thoughts about the bipedicle transverse rectus abdominus myocutaneous (tram) flap procedure and described the technical details of the operation as i performed it. Evaluation and comparison of aesthetic results and patient satisfaction with bilateral breast reduction using the inferior pedicle and mckissocks vertical bipedicle dermal flap techniques. The vertical bipedicle technique is commonly used because of a low rate of nipple necrosis and reproducibly good results. Mckissock 8, 80 believed that use of the narrowest angle possible between the limbs of the wise keyhole pattern and the addition of the lazy-s closure helped to avoid the boxy breast. The refinements and finishing touches for breast reconstruction with expanders and implants may be far different than those for a transverse rectus abdominis myocutaneous (tram) flap for immediate reconstruction or a delayed latissimus flap in an irradiated mastectomy defect.