TRAM FLAP BREAST RECONSTRUCTION AFTER RADIATION TREATMENT

Objective Patients with and without radiation treatment before their b reast reconstruction were compared to study the relationship of radiat ion to flap-related complications. Summary Background Data The transve rse rectus abdominis muscle (TRAM) flap for breast reconstruction invo lves vascular pedicle and recipient bed, both included in the radiated field of patients undergoing adjunctive therapy. Detailed reviews of flap-related complications in this subgroup of patients have been limi ted. Methods One hundred eight patients with radiation treatment who s ubsequently underwent a TRAM flap breast reconstruction were compared with 572 patients with no radiation treatment before similar reconstru ction. Flap-related complications, radiation dosage, time, fields, rel ationships between risk factors, and complications were studied. Resul ts Overall complication rates were comparable between the two groups. Only fat necrosis (>10% of total reconstruction) was found to be stati stically significant (17.6% vs. 10.1%, p = 0.03228). No difference was found for fat necrosis in unipedicled vs. bipedicled flaps controlled for radiation (17.7% vs. 17.4%). Obesity and radiation therapy were a ssociated with fat necrosis and major infection in a logistic regressi on. Significant abdominal scarring was also associated with major infe ction (p = 0.0044). Conclusions In this, the largest reported series, radiation therapy was associated with increased fat necrosis and major infection. The use of the TRAM flap was not found to be prohibitive i n radiated patients and should still be the first choice in this subgr oup of patients.