AUTOLOGOUS BREAST RECONSTRUCTION WITH USE OF TRANSVERSE RECTUS-ABDOMINIS MUSCULOCUTANEOUS FLAP - MAYO-CLINIC EXPERIENCE WITH 147 CASES

Objective: To assess the results of transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions of the breast. Design: We retrospectively reviewed 147 consecutive cases of TRAM reconstructions of the breast performed at the Mayo Clinic between 1981 and 1992. Material and Methods: The median patient age was 47 years, and the median duration of follow-up was 29 months. In 25 patients, both rectus pedicles were used, 15 of those for bilateral reconstruction. The other 122 patients had unipedicled unilateral reconstruction. Only 9 % of the breast reconstructions were immediate. Analysis of risk factors in the patient population revealed smoking in 16 %, preoperative irradiation of the chest wall in 20 %, preoperative chemotherapy in 27 %, and both radiotherapy and chemotherapy in 12 %. Results: The mean overall operative time was 4 hours and 43 minutes (4 hours and 20 minutes for unipedicled flaps and 5 hours and 46 minutes for bipedicled reconstructions). No blood transfusion was needed in 47 % of patients; of those who received transfusions, 78 % required 2 units or less. In 58 of the 147 patients (39 %), an operation was performed on the contralateral breast. Follow-up operations were necessary in 71 % of patients. The overall frequency of complications was as follows: hernia that necessitated surgical repair, 7.5 %; full TRAM ischemic loss, 3.7 %; partial TRAM loss, 9.9 %; and fat necrosis, 11.7 %. No pattern of increased complications was noted in subgroups of patients who smoked or who had received preoperative irradiation, chemotherapy, or both. In comparison with our early cases, the last 50 TRAM procedures were generally associated with fewer complications. The rates of occurrence of complications in our series of patients were similar to those reported in the literature. Conclusion: The TRAM flap provides satisfactory results for reconstruction of the breast.