Long-term evaluation of postmastectomy breast reconstruction with the pedicled transverse rectus abdominis musculocutaneous flap

Abstract

The transverse rectus abdominis musculocutaneus (TRAM) flap is ideal for unilateral breast reconstruction. It can produce a breast with a lasting natural look, soft feeling, and good resemblance to the opposite breast. The aim was to evaluate long-term results of the TRAM flap reconstruction in an homogenous study population and to examine the impact on abdominal competence, appearance, and function relative to patient satisfaction. The study included 123 women from the cohort of patients undergoing a postmastectomy breast reconstruction in the period from 1992-2005. Data was collected from patient charts, a study-specific questionnaire, and a clinical follow-up visit. The response to the questionnaire was 81% (100/123), and 78 of them participated in a clinical follow-up visit. Eighty-four per cent were satisfied with the overall results of their breast reconstruction, and the majority of the women were pleased with the overall appearance of their abdomen. A significant correlation existed between satisfaction with the abdominal appearance and donor site complications (p = 0.01). No association was determined between complications in the breast area and smoking. A BMI above 25 increased the risk of complications. Radiation therapy (RT) significantly increased the risk of severe complications (p = 0.04) and of an inferior aesthetic result (p = 0.03). In conclusion, after a median of 6 years, women reconstructed with a TRAM flap were pleased with the overall result, with the appearance and strength of their abdomen including the umbilicus. Breast reconstruction with the pedicled TRAM flap results in lasting good results and pleased patients.

Patient Factors Associated with Failure of Flap Coverage Used during Revision Total Knee Arthroplasty

“…In one study that reviewed 123 women undergoing a reconstructive flap after mastectomy, smoking was not a factor for failure. 26 With regard to patients with a history of diabetes, there are many studies that report a higher risk of infection in diabetic patients 27 and higher risk of failure after free flap treatment. 28 In one report of 33 diabetic patients undergoing lower extremity flaps, it was the patients' renal function that impacted their risk of flap failure such that patients with a preoperative creatinine greater than 1.28 were at a higher risk of failure.…”

Breast reconstruction with single-pedicle TRAM flap in breast cancer patients with low midline abdominal scar

“…Transverse rectus abdominis myocutaneous (TRAM) flap and its variations are considered the best available options for autologous breast reconstruction after mastectomy 1 2 3 4 . Abdominal scars from previous surgeries often present a challenge when TRAM flap is desired for breast reconstruction 1 2 5 6 7 8 .…”

A cost‐effectiveness analysis of DIEP vs free MS‐TRAM flap for microsurgical breast reconstruction

“…Autologous breast reconstruction involving microvascular techniques are widely used, and approximately 20% of all breast reconstructions utilize autologous tissue . Some patients may select autologous‐based reconstruction due to the resemblance of the tissue being more natural to both the look and feel of the breast, compared with implants …”

“…3 Some patients may select autologous-based reconstruction due to the resemblance of the tissue being more natural to both the look and feel of the breast, compared with implants. [4][5][6] The free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps and deep inferior epigastric perforator (DIEP) flaps are two advances in autologous abdominal-based breast reconstruction techniques that minimize the amount of rectus abdominis muscle, fascia, and nerves killed. Free MS-TRAM flap harvests a very small portion of the rectus abdominis muscle and fascia compared with older abdominalbased reconstructions, whereas DIEP flap completely spares the rectus abdominis muscle.…”