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BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINUS MYOCUTANEOUS FLAP
Author(s) -
Codner M. A.,
Weinfeld A. B.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04114_25.x
Subject(s) - medicine , breast reconstruction , surgery , mastectomy , fascia , abdominal wall , rectus abdominis muscle , abdominoplasty , implant , plastic surgery , breast cancer , cancer
In the absence of contraindications, autologous tissue reconstruction is an attractive method of breast reconstruction. The TRAM flap has become the cornerstone of autologous tissue only breast reconstruction. In most women, there is sufficient abdominal adipose tissue and skin for bilateral breast reconstruction without the need for prosthetic devices. This flap can be employed for both immediate and delayed reconstruction. It provides soft pliable tissue for post‐mastectomy reconstruction and in general has fewer radiation therapy associated complications than implant based methods of breast reconstruction. Methods Pedicled TRAM flaps are employed for breast reconstruction. Each hemi‐TRAM is based on a single pedicle. In cases of immediate breast reconstruction the flap is raised at the same time the mastectomy is being performed. In cases of DM, tobacco history, or moderate obesity, a vascular delay is performed by ligating the DIEP vessels 2 weeks prior to elevating the flap and a bipedicle flap is used to maximize blood supply. The rectus sheath fascia is repaired primarily, and the abdominal wall is reinforced with onlay marlex mesh. The TRAM flap is inset and shaped to form a youthful but mildly ptotic breast. Drains are used in both the donor site and recipient site. Long term catheter delivery of local anesthetic is employed at the donor site. Results Over the past years 10 years, 78 TRAM breast reconstructions have been performed with satisfactory to excellent results. 90% were performed for immediate reconstruction and 10% for delayed reconstructions 10% underwent surgical vascular delay of the flap for the indications discussed above and in order to avoid a free flap. There were 2 cases of total flap loss. The percentage of fat necrosis was 15%. Other complications included mastectomy skin loss (8%), hematoma/seroma (5%), and infection (5%). Revision surgery to improve the aesthetic outcome was performed in (20%). NAC reconstruction using the purse‐string method was performed in 95% of the patients. Conclusions TRAM flap breast reconstruction is a very favorable method for assisting in the overall care of a patient with breast cancer. Satisfaction is very high and major complications are acceptable. The disadvantages include longer operative time and prolonged recovery compared to tissue expander reconstruction. I feel the advantages of autologous tissue reconstruction outweigh these riskes in addition to the risks of complications associated with tissue expander, implant reconstruction. A staged approach to TRAM flap reconstruction should be considered for patients who may require postoperative radiation for local control in order to avoid the deleterious effects of radiation on the TRAM flap.