IMMEDIATE, BILATERAL TRANSVERSE RECTUS-ABDOMINIS MUSCULOCUTANEOUS (TRAM) FLAP RECONSTRUCTION AFTER MASTECTOMY

Although breast reconstruction has been shown to provide psychological benefits in mastectomy patients, there is reluctance to perform immed iate, bilateral TRAM flap reconstruction because of concerns regarding magnitude of the procedure, length of hospitalization, potential comp lications, and long-term recovery. Between June, 1990 and March 1992,1 5 patients underwent immediate, bilateral TRAM flap reconstruction fol lowing bilateral mastectomy at the University of Michigan Hospitals. D iagnoses included lobular carcinoma in situ (nine patients), strong fa mily history of breast cancer (five), or bilateral breast cancer (one) . Invasive breast cancer was present in three patients. Three modified radical mastectomies and 27 simple mastectomies were performed. Bilat eral pedicle TRAM flap reconstruction was carried out at the same time in all patients (30 flaps total). Marginal loss occurred in one flap (3%). Additional complications included marginal necrosis of the abdom inal donor site wound (one), wound infection (two), and abdominal dono r site hernia (one). Median hospital stay was 7 days. Median follow-up was 13 months (range 4-25 months). All patients have resumed their ac customed pre-operative activity patterns. These findings demonstrate t hat immediate, bilateral TRAM flap reconstruction is a safe and effect ive option for breast reconstruction after mastectomy.