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 muscul ocutaneous (TRAM) flap reconstructions of the breast. Design: We retro spectively reviewed 147 consecutive cases of TRAM reconstructions of t he breast performed at the Mayo Clinic between 1981 and 1992. Material and Methods: The median patient age was 47 years, and the median dura tion of follow-up was 29 months. In 25 patients, both rectus pedicles were used, 15 of those for bilateral reconstruction. The other 122 pat ients had unipedicled unilateral reconstruction. Only 9 % of the breas t reconstructions were immediate. Analysis of risk factors in the pati ent population revealed smoking in 16 %, preoperative irradiation of t he chest wall in 20 %, preoperative chemotherapy in 27 %, and both rad iotherapy and chemotherapy in 12 %. Results: The mean overall operativ e time was 4 hours and 43 minutes (4 hours and 20 minutes for unipedic led flaps and 5 hours and 46 minutes for bipedicled reconstructions). No blood transfusion was needed in 47 % of patients; of those who rece ived transfusions, 78 % required 2 units or less. In 58 of the 147 pat ients (39 %), an operation was performed on the contralateral breast. Follow-up operations were necessary in 71 % of patients. The overall f requency of complications was as follows: hernia that necessitated sur gical repair, 7.5 %; full TRAM ischemic loss, 3.7 %; partial TRAM loss , 9.9 %; and fat necrosis, 11.7 %. No pattern of increased complicatio ns was noted in subgroups of patients who smoked or who had received p reoperative irradiation, chemotherapy, or both. In comparison with our early cases, the last 50 TRAM procedures were generally associated wi th fewer complications. The rates of occurrence of complications in ou r series of patients were similar to those reported in the literature. Conclusion: The TRAM flap provides satisfactory results for reconstruc tion of the breast.