title: The use of the ipsilateral versus contralateral pedicle and vertical versus horizontal flap inset models in TRAM flap breast reconstruction: the aesthetic outcome.
abstract: The use of an ipsilateral or a contralateral rectus abdominis muscle as a pedicle and comparison of their advantages and disadvantages in TRAM flap breast reconstruction have been reported in the literature. In our clinical experience with 22 pedicled TRAM flap breast reconstructions, the use of either an ipsilateral or contralateral pedicle was found to be equivocal regarding the flap viability and the aesthetic outcome. Thus, it seems better to decide their use according to the needs of an individual patient. In our series, the contralateral pedicled TRAM flap with a vertical flap inset was preferred in patients with a small opposite breast or in patients with infraclavicular tissue losses (four patients). The ipsilateral pedicled TRAM flap reconstruction with a horizontal flap inset was preferred in patients with a full and attractive opposite breast, unless they received adjuvant radiotherapy (six patients). In patients who received adjuvant radiotherapy the contralateral pedicle was used regardless of the inset model preferred (10 patients). Bilateral TRAM flap breast reconstruction was applied in one of our cases, which is not included in the three categories above mentioned. The aesthetic outcome was determined by analyzing a patient satisfaction questionnaire. Overall satisfaction was achieved in 17 patients. Four patients were dissatisfied. We think that choosing the correct flap inset model is one of the most important factors in achieving a satisfactory aesthetic outcome. Choosing the correct pedicle regarding the type of the flap inset model is equally important to facilitate technical ease during flap transposition and to improve flap survival.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Istanbul Faculty of Medicine, Istanbul University, Capa, Post-code 34590, Turkey. aretmd@e-kolay.net
authors.forename: Aret
authors.initials: A
authors.lastname: Ozkan
authors.forename: Orhan
authors.initials: O
authors.lastname: Cizmeci
authors.forename: Hülya
authors.initials: H
authors.lastname: Aydin
authors.forename: Burcu Celet
authors.initials: BC
authors.lastname: Ozden
authors.forename: Burçak
authors.initials: B
authors.lastname: Tümerdem
authors.forename: Ufuk
authors.initials: U
authors.lastname: Emekli
authors.forename: Oktar
authors.initials: O
authors.lastname: Asoğlu
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Bozfakioğlu
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000534:rehabilitation*; D008875:Middle Aged; D017060:Patient Satisfaction; D013524:Surgical Flaps