Answer:
In the 1994 article titled, "Bilateral breast reconstruction: conventional versus free TRAM," the authors Baldwin, Schusterman, Miller, et al, report that in their experience, bilateral breast reconstruction using the free TRAM flap may offer a lower complication rate than the conventional TRAM flap by virtue of the improved blood supply and less abdominal wall disruption. In the conventional TRAM group, there was a 13 % incidence of partial flap loss, and a 7% incidence of fat necrosis, however no such complications occurred in the free TRAM group. However, they do warn that the learning curve is steep.
Factors that contributed to choosing free-tissue transfer included desire for immediate reconstruction, smoking history, obesity, and abdominal scarring that precluded the use of a superiorly based flap.