Wm. Jacobsen et al., AUTOLOGOUS BREAST RECONSTRUCTION WITH USE OF TRANSVERSE RECTUS-ABDOMINIS MUSCULOCUTANEOUS FLAP - MAYO-CLINIC EXPERIENCE WITH 147 CASES, Mayo Clinic proceedings, 69(7), 1994, pp. 635-640
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.