Breast reconstruction with a muscle-sparing free transverse rectus abdominis myocutaneous flap: comparison between immediate and delayed groups.
BACKGROUND
Breast reconstruction offers not only physical but also psychological rehabilitation. Autologous tissue transfer is a good option for breast reconstruction. The purpose of this study was to investigate the success rate, complications, and cosmetic outcomes following use of a muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap for breast reconstruction.


METHODS
Between August 1999 and February 2001, 15 consecutive patients underwent breast reconstruction using a muscle-sparing free TRAM flap after a mastectomy. Ten patients received mastectomies and immediately underwent breast reconstruction using muscle-sparing free TRAM flaps at Chang Gung Memorial Hospital. The remaining 5 patients first received a modified radical mastectomy and then underwent breast reconstruction.


RESULTS
The mean age of patients was 43.9 (range, 32 to 50) years. Ten patients (67%) underwent immediate reconstructions, and 5 (23%) underwent delayed reconstructions. The overall success rate was 93.3%. Postoperative complications included 1 abdominal seroma and 1 small area of breast fat necrosis. Six of 10 patients with immediate reconstruction underwent both adjuvant chemotherapy and hormone therapy, while 3 patients received only chemotherapy. None of these adjuvant therapies were delayed by the reconstructive surgery. At a mean follow-up of 26.7 months, no local recurrence had been found, and 93% of patients were satisfied with the esthetic results.


CONCLUSIONS
A muscle-sparing free TRAM flap is a good option for breast reconstruction. Both the success rate and patient satisfaction are high. The subsequent adjuvant therapy need not be delayed following immediate reconstruction.
Huang
Chi-Feng
CF
Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei.
Cheng
Ming-Huei
MH
Chen
Shin-Cheh
SC
Lo
Yung-Feng
YF
Yeh
Ta-Sen
TS
Chen
Samuel H T
SH
Huang
Wei-Chao
WC
Wei
Fu-Chan
FC
D000328:Adult; D001940:Breast / Q000098:blood supply; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D013524:Surgical Flaps