title: Immediate, bilateral transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction after mastectomy.
abstract: Although breast reconstruction has been shown to provide psychological benefits in mastectomy patients, there is reluctance to perform immediate, bilateral TRAM flap reconstruction because of concerns regarding magnitude of the procedure, length of hospitalization, potential complications, and long-term recovery. Between June, 1990 and March 1992, 15 patients underwent immediate, bilateral TRAM flap reconstruction following bilateral mastectomy at the University of Michigan Hospitals. Diagnoses included lobular carcinoma in situ (nine patients), strong family history of breast cancer (five), or bilateral breast cancer (one). Invasive breast cancer was present in three patients. Three modified radical mastectomies and 27 simple mastectomies were performed. Bilateral pedicle TRAM flap reconstruction was carried out at the same time in all patients (30 flaps total). Marginal loss occurred in one flap (3%). Additional complications included marginal necrosis of the abdominal donor site wound (one), wound infection (two), and abdominal donor site hernia (one). Median hospital stay was 7 days. Median follow-up was 13 months (range 4-25 months). All patients have resumed their accustomed pre-operative activity patterns. These findings demonstrate that immediate, bilateral TRAM flap reconstruction is a safe and effective option for breast reconstruction after mastectomy.
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Michigan Medical Center, Ann Arbor.
authors.forename: E G
authors.initials: EG
authors.lastname: Wilkins
authors.forename: D A
authors.initials: DA
authors.lastname: August
authors.forename: A D
authors.initials: AD
authors.lastname: Chang
authors.forename: D J
authors.initials: DJ
authors.lastname: Smith
mesh_terms: D000009:Abdominal Muscles / Q000637:transplantation*; D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000534:rehabilitation*; D008875:Middle Aged; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods*; D013524:Surgical Flaps / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors