Safety of immediate transverse rectus abdominis myocutaneous breast reconstruction for patients with locally advanced disease.
OBJECTIVE
Immediate transverse rectus abdominis myocutaneous breast reconstruction combined with postoperative radiation therapy after mastectomy is safe and effective.


METHODS
Retrospective case series.


METHODS
University-based teaching hospital.


METHODS
From January 1, 1996, through December 31, 2003, 252 patients underwent mastectomy and immediate transverse rectus abdominis myocutaneous flap reconstruction. Of those, 35 patients received postoperative radiation therapy (stage I, n = 1; II, n = 17; III, n = 15; IV, n = 2). Age range was 29 to 72 years (mean, 49.5 years). Follow-up was 1 to 8 years (mean, 48 months).


METHODS
Flap loss, fat necrosis, flap volume loss, adjuvant treatment delay, and need for additional surgery.


RESULTS
The rate of flap survival was 100%. Median operative time was 5.5 hours. Average hospital stay was 5.2 days. Fat necrosis occurred in 3 patients, with volume loss requiring additional surgery in 2 patients (6%). Postoperative adjuvant therapy was not significantly delayed (median interval, 32 days). With a median follow-up of 48 months, local recurrence was present in only 1 patient (3%), who underwent successful local salvage, and distant metastasis occurred in 4 patients (11%).


CONCLUSIONS
Immediate transverse rectus abdominis myocutaneous breast reconstruction followed by radiation therapy is safe, with minimal morbidity and no significant change in tissue volume. Complications tend to be minor, not delaying adjuvant therapy. Immediate breast reconstruction should be considered after mastectomy, despite the need for postoperative radiation therapy.
Foster
Robert D
RD
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA 94143-0932, USA. fosterr@surgery.ucsf.edu
Hansen
Scott L
SL
Esserman
Laura J
LJ
Hwang
E Shelley
ES
Ewing
Cheryl
C
Lane
Karen
K
Anthony
James P
JP
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty / Q000009:adverse effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018714:Radiotherapy, Adjuvant; D012867:Skin / Q000528:radiation effects; D013524:Surgical Flaps; D013997:Time Factors