ABDOMINAL SEQUELAE AFTER PEDICLED TRAM FLAP BREAST RECONSTRUCTION

A considerable interest in autologous tissue breast reconstructions ha s developed recently, especially since Food and Drug Administration (F DA) experts have raised the polemic on silicone implants. Although suc h enthusiasm for the transverse rectus abdominis musculocutaneous (TRA M) flap is justified in what concerns the final cosmetic result of the reconstructed breast, the risk of abdominal sequelae should be explai ned to the patient. Abdominal scarring, parietal weakness, strength lo ss, and back pain have been recorded in a series of pedicled TRAM flap reconstructions performed at the Institut Gustave-Roussy before 1991. Cosmetic results of the abdomen were tested by three independent judg es on the photographs taken of 132 patients. The global appearance of the abdomen was rated as ''natural'' in 70 percent of the patients. Th e umbilical scar was unacceptable in 25 percent and very good or not v isible in 21 percent. The lower abdominal scar was rated as ''not acce ptable'' in 35 percent. Abdominal strength was tested among the 38 pat ients who underwent both preoperative and postoperative muscular testi ng, of whom 18 had single-pedicled and 20 had bipedicled TRAM flap rec onstructions. In the first group, the physiotherapist observed an impa irment of function of the upper portion of the rectus abdominis and of the oblique muscle in almost 50 percent. In the second group, the sam e muscles were more severely impaired (in 60 percent), as well as the function of the lower portion of the rectus (in 15 percent). The perce ntage of patients complaining of ''light back pain'' in the 6-month po stoperative period was 55 percent in the single-pedicle group and 30 p ercent in the double-pedicle group. However, 20 percent of the bipedic led patients complained of ''severe'' back pain, while there was none in the single-pedicled group. In conclusion, abdominal sequelae after TRAM flap breast reconstruction should not be underestimated and const itute,ne of the drawbacks of the technique when it is compared with re construction with a prosthesis.