OUTCOMES OF BREAST RECONSTRUCTION WITH PEDICLED TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS (TRAM) FLAP AT CANCER INSTITUTE, A RETROSPECTIVE STUDY OF 10 YEARS OF EXPERIENCE

Abstract

Reconstruction of breast with transverse rectus abdominis myocutaneous (TRAM) flap is the standard for reconstruction of breast following mastectomy. In this article, authors report their experience with pedicled TRAM flap reconstruction of the breast. Records for the patients who had undergone breast reconstruction with pedicled TRAM flap were retrieved. Records of outpatient follow-ups were also obtained. Patient satisfaction with the outcome of surgery was assessed using a detailed questionnaire including a linear visual analogue scale ranging from zero (not satisfied) to ten (most satisfied). There were 61 reconstructions in 59 patients. In 42 (71.2%) cases a synthetic mesh and in 14 (23.7%) cases dermal graft was used for closure of the abdominal fascial defect. The mean hospital stay was 10.67 (1 - 72) days. Patients were followed up for a mean period of 621 days. The overall rates of complications were as follows: partial flap necrosis: 11 (18.6%), flap hematoma: 2 (3.4%), flap seroma: 7 (11.9%), flap wound infection: 7 (11.9%), abdominal wound hematoma: 9 (15.3%), abdominal wound seroma: 5 (8.5%), abdominal wound ischemia: 1 (1.7%), abdominal wound incisional hernia: 6 (10.2%), deep vein thrombosis: 1 (1.7%), complication requiring rehospitalization: 9 (15.3%), complication requiring reoperation: 8 (13.6%). There were no abdominal wound infection, no umbilical necrosis, and no pulmonary embolism. Aesthetic results were classified as excellent (62%), good (28%), fair (10%). The mean satisfaction score was 9.5 (range 6-10). Breast reconstruction with pedicled transverse rectus abdominis myocutaneous flap was associated with a low complication rate and a high level of patient satisfaction in our center.