The main disadvantage when the transverse rectus abdominis musculocutaneous (TRAM) flap is used for breast reconstruction is the potential for weakening of the abdominal wall. This prospective study was initiated to objectively evaluate abdominal muscle strength after pedicled and free TRAM flap breast reconstructions over time. Twenty-three patients with pedicled TRAM flaps and 19 patients with free TRAM flaps were included. A dynamic dynamometer system, KIN-COM, was used to measure maximal voluntary trunk flexor and extensor strength preoperatively and 6 and 12 months postoperatively. The patients' subjective opinions 1 year postoperatively were recorded by means of a questionnaire. A transient decrease in abdominal strength, in both groups, occurred at 6 months but was essentially regained at 12 months. The use of a pedicled or free TRAM flap did not influence postoperative abdominal strength per se. The balance between the abdominal strength and back strength remained in the free flap group but was altered postoperatively in the pedicled flap group; back strength was increased and remained so after 12 months. The difference between the two procedures is relatively small compared with individual variations, indicating that there are more important factors than the kind of surgery influencing the restoration of muscle strength. The questionnaire revealed a greater occurrence of abdominal wall bulging in the free flap group (82 percent) versus 48 percent in the pedicled flap group. No postoperative differences regarding exercise frequency or sensitivity of the abdominal wall were found between the pedicled and free TRAM flap groups.

The most common complication in flap surgery is of a circulatory nature. Impeded blood flow leads to altered metabolism in the tissue. Possible metabolic differences between different zones of the transverse rectus abdominis muscle (TRAM) flap were studied and the metabolism of pedicled and free TRAM flaps was compared intraoperatively and postoperatively. The method used was microdialysis, which is a useful technique for following local metabolic changes continuously in various tissues.Twenty-two patients with a pedicled or free TRAM flap were monitored using the microdialysis technique. Two microdialysis catheters were placed subcutaneously in the flap (zone I and zone II), and a third one was placed subcutaneously in the flank to serve as a control. The flaps were monitored intraoperatively and postoperatively for 3 days with repeated analyses of extracellular glucose, lactate, and glycerol concentrations. An additional analysis of pyruvate was performed in some patients to calculate the lactate-to-pyruvate ratio. This study showed that glucose, lactate, and glycerol change in a characteristic way when complete ischemia (i.e., complete inhibition of the blood circulation) is present. A slower stabilization with prolonged metabolic signs of ischemia, such as lower glucose and higher lactate and glycerol concentrations, was seen in zone II compared with zone I, and more pronounced metabolic signs of ischemia, but with a faster recovery, were detected in the free TRAM flap group than in the pedicled TRAM flap group. The fact that the metabolites returned to normal earlier in free flaps than in pedicled flaps may indicate that free TRAM flaps sustain less ischemic damage because of better and more vigorous perfusion.

A pilot study was carried through to assess the reproducibility of a new method of measuring breast volume. Twenty healthy female volunteers participated. A negative replica of the breast was made with thermoplastic cast material. The volume was measured by filling the cast with water until it reached two opposite points of the boundaries of the breast delineated on the cast. Three measurements were made of every cast and the mean was calculated. The range of the three measurements expressed as a percentage of the mean volume was 2.9 (SD 1.6)%. Each volunteer's breasts were measured twice with a brief intervening pause. The coefficient of variation between the two corresponding measurements was 6%.

Macromastia is a common indication for breast reduction within the public health care system in Sweden. To reduce the waiting time, a project was launched to operate on patients during a three-month period at a local hospital in Stockholm (Nacka Hospital). The operations were done by specialists and residents from the Karolinska University Hospital, using a medial flap technique. The aim of this prospective study was to evaluate the results of this project, focusing on clinical outcome, quality of life, patients' satisfaction, and aesthetic results. Personal and preoperative clinical data and information about risk factors were extracted from the patients' records. At the 6 month follow-up the patients were asked to fill in two questionnaires: "Short Form-36" and another form about patients' satisfaction and sensitivity. Four digital photos taken during the follow-up were graded by three plastic surgeons. Diabetes and oral contraceptives, respectively, were risk factors for infection and delayed wound healing. Patients reported a significantly increased quality of life after six months, regardless of body mass index. Patients were generally more satisfied with the aesthetic outcome than were the surgeons, had satisfactory aesthetic results (89%), acceptable levels of complications (31%), and increased quality of life. The medial flap technique should be evaluated further for its loss of sensitivity.