title: [A clinic study of transverse rectus abdominis myocutaneous flap in immediate breast reconstruction with refined breast incisions of breast mastectomy].
abstract: OBJECTIVE
  To discuss the aesthetic effect and application of refined incisions in breast reconstruction for breast cancer patients by the transverse rectus abdominis myocutaneous (TRAM) flap.
  
  
  METHODS
  From January 2001 to October 2006, 77 cases with breast cancer were treated with TRAM flap to immediate breast reconstruction. The patients were all females, with an average age of 45 years (ranging from 26 years to 53 years). There were 39 cases of left breast and 38 cases of right breast. The disease course was from 1 day to 180 days. There were 11 cases of stage I, 60 cases of stage II and 6 cases of stage III, among which 34 cases were located in the upper outer quadrant, 15 in the lower outer quadrant, 22 in the upper inner quadrant and 6 in the lower inner quadrant. The size of tumors varied from 1 cm to 4 cm. As to the pathologic type, 60 cases were invasive ductal cancers, 12 ductal cancers in situ, 5 invasive lobular cancers; positive lymph node (number: 1-7) happened in 29 cases, while negative lymph node happened in 48 cases. Among the 77 cases, regular shuttle incisions were performed in 35 cases, and refined circle incisions were performed in 42 cases, which were 2 cm away from the breast tumor border. Axillary incision was necessary for the breast tumors located in upper inner, lower inner and upper outer quadrants in order to perform axillary mastectomy. Ten cases were nipple-areola sparing. The shape, symmetry and incision scar of the reconstructed breast were evaluated and graded.
  
  
  RESULTS
  There were 6 cases out of 77 cases of breast reconstruction in which partial necrosis happened and the necrosis rate was 7.79%. The time of follow-up was from 13 months to72 months, with an average of 39 months. No recurrence or metastasis happened in 76 cases, and distant metastasis happened only in 1 case. There were 40 cases out of 42 cases with refined incisions which were scored more than 3, and the satisfaction rate was 95.24%. There were 31 cases out of 35 cases with regular incisions which were scored more than 3, and the satisfaction rate was 88.57%.
  
  
  CONCLUSIONS
  The reasonable refined incision based on the location of the tumor is effective to improve the satisfaction rate for the shape of the reconstructed breast.
authors.affiliation: Department of Breast, Affiliated Cancer Hospital, Tianjin Medical University, Tianjin, 300060, P.R.China. xxcchh2002@163.com
authors.forename: Chunhua
authors.initials: C
authors.lastname: Xiao
authors.forename: Xuehui
authors.initials: X
authors.lastname: Zhang
authors.forename: Jian
authors.initials: J
authors.lastname: Yin
authors.forename: Liansheng
authors.initials: L
authors.lastname: Ning
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011184:Postoperative Period; D017568:Rectus Abdominis / Q000637:transplantation*