“Simultaneous bulge repair and recontouring after abdominally based breast reconstruction: A well-fixed open transversus abdominis release approach”

An abdominal bulge is an often-underreported complication of abdominally based breast reconstruction (ABBR) with no gold standard treatment. A bulge confers significant morbidity to patients through compromised core function and a poor aesthetic contour. We present here a new technique for bulge repair that addresses both aspects through an open transversus abdominis release (TAR) with a well-fixed, polypropylene mesh. An electronic data warehouse query was initiated using keywords "bulge" and "TAR" for the senior author's (GAD) patients from 2020-2025 for bulge repair after ABBR. A total of 11 patients were included in the final analysis. Medical and surgical history, operative details, and clinic follow-up were collected. The average age was 58 years old with a mean BMI of 29.3 (max 38.2). The average interval time between ABBR and bulge development was 127 days. Five patients failed a previous bulge repair, either planar mesh onlay with plication (n=3) or plication only (n=2). All patients endorsed complete resolution of bulge symptoms after TAR intervention with no clinical recurrences during an average follow-up of 379 days. Average width of the polypropylene mesh was 17.6 centimeters. There was one postoperative seroma and one incidence of focal, superficial delayed wound healing that resolved spontaneously. Clinical photography is presented to demonstrate the resulting aesthetic contour of the abdomen. The described open TAR with a large, well-fixed polypropylene mesh targets and re-tensions the attenuated inferior abdominal wall after ABBR. It is well-tolerated and reproducible across common permutations of postoperative bulge anatomy.