THE EFFECTS OF RADIATION TREATMENT AFTER TRAM FLAP BREAST RECONSTRUCTION

A subgroup of mastectomy patients receives adjuvant radiation therapy after autogenous breast reconstruction for locoregional control of can cer. The effects of radiation therapy on pedicled transverse rectus ab dominis musculocutaneous (TRAM) flaps were determined to evaluate comp lication rates and aesthetic results. Nineteen patients from 1981 to 1 994 receiving radiation therapy after a pedicled TRAM flap reconstruct ion were compared with 108 patients who received radiation prior to re construction and 572 patients who underwent breast reconstruction with out radiation. Retrospective reviews of patient charts were completed. Adjuvant radiation therapy was given for chest-wall recurrence in 13 o f 19 patients. With a mean follow-up of 47.6 months from the time of r econstruction, 10 patients (52.6 percent) demonstrated postradiation c hanges in the TRAM flap reconstruction, and 6 required surgical interv ention (31.6 percent). Overall complication rates were increased but w ere not found to be statistically significant between the radiated TRA M flap group and patients with preoperative radiation followed by TRAM flap reconstruction (31 versus 25 percent). Fibrosis was not found in patients with pre-TRAM flap radiation or in patients without radiatio n but was seen in 31.6 percent of patients who received radiation afte r the reconstruction. Fat necrosis was not significantly increased bet ween the two groups of radiated patients. The complication rate does n ot change whether a patient receives radiation before or after her rec onstruction; only the nature of the complication changes (fat necrosis to fibrosis).