Comparison of the early and late postoperative results in cases with pedicled transverse rectus abdominis musculocutaneous flap breast reconstruction: Twenty-year follow-up

Abstract

Background: The TRAM flap has proven to be the autogenous tissue of choice for breast reconstruction. The progressive improvement of the aesthetic results in long-term follow-up of patients with well-executed TRAM flap breast reconstructions is observed to be highly satisfactory for both patients and the surgeon. Aims and Objectives: In this article, I aimed to present long term results of cases with pedicles TRAM flap reconstruction. Material and Methods: Between January 1999 and July 2001 period, 22 pedicled TRAM flap breast reconstructions were performed to 21 patients with breast carcinoma. The mean age of the patients was 42 (28-53) years. In this study, the contralateral rectus abdominis muscle was preferred as a pedicle in patients who had received adjuvant radiotherapy- (10 patients) and vertical or oblique flap inset was applied in most of them- (9 patients). In patients without adjuvant radiotherapy but with infraclavicular tissue losses, or with small opposite breast, again vertical or oblique flap inset was preferred- (4 patients). In all patients with vertical or oblique flap inset, the contralateral rectus abdominis muscle was used as a pedicle- (13 patients). In patients with full and attractive opposite breast, horizontal flap inset was preferred- (7 patients). In patients with horizontal flap inset, ipsilateral rectus abdominis muscle was used as a pedicle unless the patient had received adjuvant radiotherapy- (6 patients); contralateral rectus abdominis muscle was used as a pedicle if the patient had received adjuvant radiotherapy- (1 patient). Results: The follow-up period is 18-20 years for this series. During the early postoperative days, highly satisfactory results have been obtained. Eighteen of the cases were totally satisfied. Three of the cases had dissatisfactions mostly related to complications. During 18 to 20 years period follow-up of 12 patients has been performed regularly. Oncologic tracing, the degree of maintenance of the breast shape of the flap and symmetry, softness, and naturality of the reconstructed breast, maturational changes in surgical scars, abdominal strength, sensational changes over the flap skin, color and shape changes over nipple areola complex have all been periodically observed. Conclusion: TRAM flap is still the gold standard among all breast reconstruction modalities. Progressive improvement in all measures such as breast, symmetry, softness, and naturality of the reconstructed breast, maturational changes in surgical scars, abdominal strength, sensational changes over the flap skin are very satisfactory for patients and the surgeon.