title: Locoregional recurrence after mastectomy with immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction.
abstract: BACKGROUND
  The locoregional recurrence (LRR) rate after mastectomy is reported to be similar with immediate reconstruction. We aimed to identify characteristics of LRR after transverse rectus abdominis myocutaneous (TRAM) reconstruction.
  
  
  METHODS
  We retrospectively reviewed patients undergoing immediate TRAM reconstruction for breast cancer who were diagnosed with LRR.
  
  
  RESULTS
  We identified 18 LRR (4.6 %) in 18 of 390 patients who underwent immediate TRAM reconstructions for breast cancer from 1998 to 2008. The median follow-up was 69.2 months. The mean age at time of mastectomy was 49.5 years. All LRR were detected by physical examination. The LRR occurred in the TRAM subcutaneous tissue (n = 9), five in the ipsilateral axillary lymph node and four in the supraclavicular lymph node. Of the 18 patients who developed LRR, 14 (77.7 %) presented with stage 0-1-2 and 4 (22.2 %) with stage 3 disease at the time of the original mastectomy. The average time for a LRR to present was 35.8 months after initial mastectomy and reconstruction. For patients who initially presented with stage 3 disease, the average time to LRR was shorter (22.9 months). Nine patients (50.0 %) were found to have metastatic disease at the time of the LRR, and 6 (33.3 %) died of disease.
  
  
  CONCLUSIONS
  All TRAM LRR were detected by routine physical examination by the patient or the surgeon. Our findings suggest that routine history and clinical breast examination of the breast reconstructed with a TRAM flap along with patient self-awareness are reliable in the diagnosis of LRR.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Sharla Gayle
authors.initials: SG
authors.lastname: Patterson
authors.forename: Paige
authors.initials: P
authors.lastname: Teller
authors.forename: Radha
authors.initials: R
authors.lastname: Iyengar
authors.forename: Grant W
authors.initials: GW
authors.lastname: Carlson
authors.forename: Sheryl G A
authors.initials: SG
authors.lastname: Gabram-Mendola
authors.forename: Albert
authors.initials: A
authors.lastname: Losken
authors.forename: Toncred
authors.initials: T
authors.lastname: Styblo
authors.forename: Mylin
authors.initials: M
authors.lastname: Torres
authors.forename: William C
authors.initials: WC
authors.lastname: Wood
authors.forename: Sebastian D
authors.initials: SD
authors.lastname: Perez
authors.forename: Marina
authors.initials: M
authors.lastname: Mosunjac
authors.forename: Monica
authors.initials: M
authors.lastname: Rizzo
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D017568:Rectus Abdominis / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000601:surgery*; D015996:Survival Rate