IMMEDIATE BREAST RECONSTRUCTION FOR STAGE-III BREAST-CANCER USING TRANSVERSE RECTUS-ABDOMINIS MUSCULOCUTANEOUS (TRAM) FLAP

Background: The management of stage III breast cancer is challenging; it often includes multimodal treatment with systemic therapy and/or ra diation therapy and surgery, Immediate breast reconstruction has not t raditionally been performed in these patients, We review the results o f immediate transverse rectus abdominis musculocutaneous (TRAM) flap i n 21 patients treated for stage III breast cancer. Methods: Data have been collected retrospectively on 21 patients diagnosed with stage III breast cancer between 1987 and 1994. All patients had mastectomy and immediate TRAM reconstruction. Thirteen patients received primary syst emic therapy, 10 patients received postoperative consolidation radioth erapy to the operative site, and 3 patients received preoperative radi ation. Results: Mean follow-up for the group was 26 months, Two patien ts died with disseminated disease: neither of them developed local dis ease recurrence in the operative site; 82% of the patients followed fo r at least two years are free of disease. Sixty-two percent of the pat ients received preoperative chemotherapy, the remaining patients recei ved postoperative multiagent chemotherapy and/or radiation therapy. Tw o of the patients received autologous bone marrow transplants after th eir adjuvant therapy. Ten patients had postoperative radiotherapy for consolidation; three patients received preoperative radiation. Conclus ions: Immediate TRAM reconstruction for stage III breast cancer is not associated with a delay in adjuvant therapy or an increased risk of l ocal relapse. It facilitates wide resection of involved skin without s kin grafting, Radiation therapy can be delivered to the reconstructed breast when indicated without difficulty, Breast reconstruction facili tates surgical resection of stage III breast cancer with primary closu re and should be considered if the patient desires immediate breast re construction.