title: Endoscopy-Assisted Total Mastectomy Followed by Immediate Pedicled Transverse Rectus Abdominis Musculocutaneous (TRAM) Flap Reconstruction: Preliminary Results of 48 Patients.
abstract: BACKGROUND
  Endoscopy-assisted breast surgery performed through minimal axillary and/or periareolar incisions is a viable option for patients with breast cancer. In this study, we report the preliminary results of patients with breast cancer who underwent endoscopy-assisted total mastectomy (EATM) followed immediately by pedicled transverse abdominis musculocutaneous (TRAM) flap reconstruction.
  
  
  METHODS
  Patients in this study comprised women with breast cancer who received EATM and pedicled TRAM flap reconstruction. Clinicopathologic characteristics, type of surgery, complications, and rate of recurrence were recorded. The cosmetic outcomes were evaluated objectively by the surgeons and subjectively by the patients at 3-month postoperative follow-up.
  
  
  RESULTS
  A total of 48 patients underwent 49 EATM procedures followed by pedicled TRAM flap reconstruction. Of them, 79.6% underwent endoscopic-assisted nipple-sparing mastectomy and 20.4% received endoscopic-assisted skin-sparing mastectomy. The types of cancer among these patients included ductal carcinoma in situ in 34.7%, stage I cancer in 36.7%, stage II cancer in 24.5%, and stage IIIa cancer in 4.1% patients. Mean tumor size was 2.1 ± 1.4 cm. There were no cases of flap failure. Partial nipple areolar complex ischemia/necrosis occurred in 4 (10.3%) patients; however, all cases resolved after conservative treatment. In the aesthetic outcome evaluation, EATM + TRAM were associated with 89.8% good, 8.2% fair, and 2% unsatisfactory result. No local recurrence was observed during the follow-up period.
  
  
  CONCLUSIONS
  EATM followed immediately by pedicled TRAM flap reconstruction is a safe procedure and results in good cosmetic outcome in women with early-stage breast cancer.
authors.affiliation: Endoscopy and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan, Republic of China National Yang Ming University, Taipei, Taiwan, Republic of China.
authors.forename: Hung-Wen
authors.initials: HW
authors.lastname: Lai
authors.affiliation: Show-Chwan Memorial Hospital, Changhua, Taiwan, Republic of China Asian Institute of TeleSurgery/IRCAD Taiwan Training Center, Changhua County, Taiwan, Republic of China National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Hurng-Sheng
authors.initials: HS
authors.lastname: Wu
authors.affiliation: National Cheng-Kung University Hospital, Tainan and Dou-Liou Branch, Taiwan, Republic of China.
authors.forename: Kun-Lin
authors.initials: KL
authors.lastname: Chuang
authors.affiliation: Endoscopy and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan, Republic of China.
authors.forename: Dar-Ren
authors.initials: DR
authors.lastname: Chen
authors.affiliation: National Cheng-Kung University Hospital, Tainan and Dou-Liou Branch, Taiwan, Republic of China.
authors.forename: Tsai-Wang
authors.initials: TW
authors.lastname: Chang
authors.affiliation: Endoscopy and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan, Republic of China.
authors.forename: Shou-Jen
authors.initials: SJ
authors.lastname: Kuo
authors.affiliation: Endoscopy and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan, Republic of China ylkuo@mail.ncku.edu.tw 1886@cch.org.tw.
authors.forename: Shou-Tung
authors.initials: ST
authors.lastname: Chen
authors.affiliation: National Cheng-Kung University Hospital, Tainan and Dou-Liou Branch, Taiwan, Republic of China ylkuo@mail.ncku.edu.tw 1886@cch.org.tw.
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Kuo
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods; D011183:Postoperative Complications; D017568:Rectus Abdominis / Q000601:surgery*; D013524:Surgical Flaps / Q000601:surgery*
keywords: endoscopic-assisted total mastectomy (EATM); immediate breast reconstruction; pedicled transverse abdominal musculocutaneous (TRAM) flap