title: Bilateral breast reconstruction: conventional versus free TRAM.
abstract: Free TRAM flap transfer is now routinely offered to patients requiring breast reconstruction. This study compares results of conventional superior-pedicled TRAM flaps and free TRAM flaps in bilateral breast reconstructions. A total of 92 breasts were reconstructed in 46 patients. Eighteen patients had free TRAM flap reconstructions, and 28 patients were reconstructed with conventional TRAM flaps. Comparison of average operative blood loss and average operative time for the two techniques showed blood loss of 575 cc and an operative time of 9.6 hours for the free TRAM reconstructions and a blood loss of 313 cc and an operative time of 6.6 hours for the conventional TRAM reconstructions. For free TRAM flap reconstructions, both blood loss and operative time decreased significantly between the first and second group of nine patients: from 819 to 360 cc of blood loss and from 10.5 to 8.9 hours of operative time. Partial flap loss (skin and fat necrosis) and fat necrosis only occurred in 13 and 7 percent, respectively, of conventional TRAM flaps, but neither occurred in free TRAM flaps. However, early in the series, three free flaps were lost in two patients, requiring implant placement. Bilateral breast reconstruction using the free TRAM flap may offer a lower complication rate than the conventional TRAM flap by virtue of improved blood supply and less abdominal wall disruption. Surgeons, however, are forewarned that this procedure has a steep learning curve, and surgeons lacking microsurgical expertise may be better served by the conventional TRAM flap.
authors.affiliation: Department of Reconstructive and Plastic Surgery, University of Texas M.D. Anderson Cancer Center.
authors.forename: B J
authors.initials: BJ
authors.lastname: Baldwin
authors.forename: M A
authors.initials: MA
authors.lastname: Schusterman
authors.forename: M J
authors.initials: MJ
authors.lastname: Miller
authors.forename: S S
authors.initials: SS
authors.lastname: Kroll
authors.forename: B G
authors.initials: BG
authors.lastname: Wang
mesh_terms: D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000534:rehabilitation; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000379:methods*; D013997:Time Factors