Long-Term Serial Measurement of Muscle Volume in TRAM Flaps Using the Eclipse Treatment Planning System

Han, Woo Yeon; Lee, Sumin; Kim, Eun Key; Lee, Taik Jong

doi:10.1097/prs.0000000000005609

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…When looking at the muscle:fat ratio, similar results to head and neck reconstruction were seen in TRAM flap breast reconstruction. Muscle tissue in TRAM flaps underwent a significant reduction of 70% after 15 months following the initial breast reconstruction in patients without adjuvant radiotherapy [ 77 ]. Studies evaluating the DIEP flap, often considered the workhorse flap, have reported volume losses ranging from a slight increase to a decrease of 26%, aligning with findings from adipose flaps used in head and neck reconstructive procedures [ 35 , 36 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Adjuvant Radiotherapy on Free Flap Volume in Autologous Breast Reconstruction: A Scoping Review

Pfister,

Müller,

Eberhardt

et al. 2023

JCM

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In autologous breast reconstruction, a sufficient flap volume is fundamental to restore breast shape and ensure an aesthetic outcome. After mastectomy, postoperative irradiation is regularly indicated in the oncological treatment algorithm. When administering radiation therapy after autologous reconstruction, the tissue transferred is inherently irradiated. Although there is evidence that points to a reduction in flap volume after adjuvant radiotherapy, the data have been contradicting and inconclusive. To address this anecdotal evidence, we performed a scoping review of the current literature that addresses the effect of radiotherapy on breast flap volume. Six two-armed studies, comprising a total of 462 patients, reported on the effect of adjuvant radiotherapy on free flap volume changes. Of those, two studies found a significant negative impact of radiotherapy on free flap volume, while the other four studies did not. Reported flap volume changes ranged from no change to a reduction of 26.2%, measured up to two years postoperatively. The selected studies contain varying patient numbers, follow-up timepoints, types of flaps, and measuring methods, contributing to a relatively high heterogeneity. While we present some evidence suggesting a significant impact of adjuvant radiotherapy on breast flap volume, future studies are needed to further investigate this potential correlation.

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Section: Discussionmentioning

confidence: 99%

Impact of Adjuvant Radiotherapy on Free Flap Volume in Autologous Breast Reconstruction: A Scoping Review

Pfister,

Müller,

Eberhardt

et al. 2023

JCM

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“…The flap volume of muscle flaps such as a transverse rectus abdominis musculocutaneous (TRAM) flap and latissimus dorsi (LD) flap decreases over time from denervation and disuse atrophy. [4][5][6][7] A recent report illustrated that the muscle of a TRAM flap lost more than 70 percent of its volume in the first 15 months and reduced to approximately 20 percent of its original size. 6 However, it is unclear whether the volume of the breast decreases or not following DIEP flap breast reconstruction.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7] A recent report illustrated that the muscle of a TRAM flap lost more than 70 percent of its volume in the first 15 months and reduced to $20 percent of its original size. 6 However, it is unclear whether the volume of the breast decreases or not following DIEP flap breast reconstruction. This study aimed to assess, through utilizing 3D surface imaging, whether the reconstructed breast volume changed postoperatively after a DIEP flap.…”

mentioning

confidence: 99%

Three-dimensional Volume Changes of the Reconstructed Breast Following DIEP Flap Breast Reconstruction

Lee

Park

et al. 2022

J Reconstr Microsurg

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Background This study aimed to assess whether the reconstructed breast volume changed postoperatively following a deep inferior epigastric artery perforator (DIEP) flap. Methods Patients were included if they had undergone unilateral breast reconstruction with a DIEP flap at the two selected centers between April 2017 and September 2019. Serial 3-D surface imaging of both breasts was taken at 1, 3, 6, and 12 months postoperatively. The primary outcome was a volume ratio of the reconstructed to the contralateral breast. A linear mixed-effect model was used to evaluate whether the DIEP flap volume changed according to the postoperative time. Results A total of 74 patients were included in the analysis. The mean volume ratio of the reconstructed side compared to the contralateral breast at 1, 3, 6, and 12 months postoperatively were 106.9 %, 105.9 %, 108.7 %, and 107.6 %, respectively. In the linear mixed effect model, the volume ratio of the reconstructed breast did not change over time for immediate reconstructions (p = 0.376). However, there was an increase over time in delayed reconstructions (p = 0.043). Adjuvant radiation, chemotherapy, and hormone therapy did not influence the volume ratio of the reconstruced breast. Correlation analysis using repeatedly measured values showed that both reconstruced and healthy breast volumes had positive correlation with the patient’s body weight (p < 0.001). On the other hand, volume ratio of the breasts was not influenced by the patient’s body weight (p = 0.493). The volume ratio of the reconstructed breast significantly decreased in the upper inner (p = 0.003) and the upper outer (p = 0.006) quadrants, while increasing in the lower outer (p = 0.002) quadrant throughout the first-year postoperative period. Conclusion The volume ratio of the reconstructed to the contralateral breast does not decrease postoperatively following DIEP flap breast reconstruction.

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“…[1][2][3] In addition, some studies have examined these volume changes in cases of pedicled flaps rather than free flaps. 4,5 Muscle or myocutaneous (MC) flaps were used often in the past, and reinnervation was usually not performed, because the muscle was only used to fill the volume. In case of breast reconstruction using the latissimus dorsi muscle, denervation was performed to prevent animation deformity.…”

mentioning

confidence: 99%

“…Several studies have reported flap volume changes after free tissue transfer 1–3 . In addition, some studies have examined these volume changes in cases of pedicled flaps rather than free flaps 4,5 . Muscle or myocutaneous (MC) flaps were used often in the past, and reinnervation was usually not performed, because the muscle was only used to fill the volume.…”

mentioning

confidence: 99%

Three-Dimensional Analysis of Flap Volume Change in Total Tongue Reconstruction: Focus on Reinnervated Dynamic Tongue Reconstruction

Woo,

Kim,

Jeong

et al. 2023

Journal of Craniofacial Surgery

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In general, flap volume decreases over time and further in the case of a denervated muscle flap. In our institution, dynamic reconstruction, including functional muscle flaps, has been used to aid functional recovery in the past 6 years. This study aimed to determine the effect of volume change of the fat and muscular sections of reconstructed tongue flaps after motor nerve reinnervation in dynamic total tongue reconstruction using 3-dimensional measurement and analysis. A retrospective chart review was performed on 21 patients who underwent total tongue reconstruction using an anterolateral thigh free flap from 2015 to 2020. The fat and muscle volumes of the flap were measured using computed tomography data obtained before surgery (T0), 2 weeks after surgery (T1), and 6 months after surgery (T2) using a 3-dimensional rendering software. Among the 21 patients that underwent tongue reconstruction, 10 underwent dynamic reconstruction, whereas 11 underwent conventional reconstruction using a fasciocutaneous flap. T2 volume compared with T1 was 69.08% in the conventional reconstruction group, and the fat and muscle portions in the dynamic reconstruction group were 77.04% and 69.06%, respectively. No significant difference was noted in the volume change between the 2 groups. After dynamic tongue reconstruction, the muscular volume of the flap had similar volume reduction rate as the fat volume. The dynamic reconstruction was effective not only for functional muscle transfer but also for maintaining the volume of the reconstructed muscle flap.

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Long-Term Serial Measurement of Muscle Volume in TRAM Flaps Using the Eclipse Treatment Planning System

Cited by 6 publications

References 18 publications

Impact of Adjuvant Radiotherapy on Free Flap Volume in Autologous Breast Reconstruction: A Scoping Review

Impact of Adjuvant Radiotherapy on Free Flap Volume in Autologous Breast Reconstruction: A Scoping Review

Three-dimensional Volume Changes of the Reconstructed Breast Following DIEP Flap Breast Reconstruction

Three-Dimensional Analysis of Flap Volume Change in Total Tongue Reconstruction: Focus on Reinnervated Dynamic Tongue Reconstruction

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