title: Effects of radiation therapy on pedicled transverse rectus abdominis myocutaneous flap breast reconstruction.
abstract: Radiotherapy is being increasingly used in the treatment of breast cancer after breast conservation as well as after total mastectomy. The effect of radiation on pedicled transverse rectus abdominis myocutaneous (TRAM) flap reconstruction is examined. A retrospective review of 199 patients undergoing 232 pedicled TRAM flap reconstructions was performed to identify patients who received radiotherapy. Patients were stratified into 5 groups by the use and timing of radiation as well as the timing of the reconstruction. The overall esthetic appearances were assessed by blinded reviewers. The incidence of flap complications was 34.2% in the immediate nonirradiated group, 10.7% in the delayed nonirradiated group, 44% in the post-TRAM radiation group, 60% in the immediate pre-TRAM radiation group, and 33% in the delayed pre-TRAM radiation group (P = 0.010). Patients who had immediate TRAM flap reconstruction and did not receive radiation had a better global esthetic outcome (P < 0.001) than the other 4 groups. The esthetic outcome was similar whether radiation was administered pre- or post-TRAM flap reconstruction. Radiation therapy has a deleterious effect on the esthetic outcome of pedicled TRAM flap reconstruction whether administered before or after reconstruction. There was no difference in TRAM flap complications in any of the groups that received radiation therapy.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA. grant_carlson@emory.org
authors.forename: Grant W
authors.initials: GW
authors.lastname: Carlson
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Page
authors.forename: Kendall
authors.initials: K
authors.lastname: Peters
authors.forename: Russell
authors.initials: R
authors.lastname: Ashinoff
authors.forename: Timothy
authors.initials: T
authors.lastname: Schaefer
authors.forename: Albert
authors.initials: A
authors.lastname: Losken
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects*; D017568:Rectus Abdominis / Q000098:blood supply* / Q000637:transplantation; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply*