MAMMOGRAPHY IN THE EVALUATION OF MASSES IN BREASTS RECONSTRUCTED WITHTRAM FLAPS

Patients with transverse rectus abdominis musculocutaneous (TRAM) flap s may develop physical findings, such as palpable masses, irregulariti es, and areas of increased tenderness that are suggestive of fat necro sis or recurrent malignancy. The purpose of this study was to evaluate these findings with mammography in an attempt to rule out recurrent m alignancy in the autogenously reconstructed breast. Fifteen patients o n whom mammography was performed as an aid in the evaluation of suspic ious post-TRAM flap findings were reviewed. Common mammographic findin gs included calcifications believed to demonstrate fat necrosis, benig n dermal calcifications, calcified hematoma, and clustered microcalcif ications. Areas of increased or decreased density without calcificatio ns were also identified and appeared to be related to surgical changes and fat necrosis. Twenty percent of patients had clustered microcalci fications, and 20% had detectable masses on mammography, One patient h ad a suspicious mass associated with clustered microcalcifications, le ading to a biopsy that revealed fat necrosis. The majority of findings were consistent with normal fat within the TRAM flaps. This study sup ports mammography as a useful diagnostic tool in patients who have und ergone TRAM flap breast reconstruction and who present postoperatively with suspicious physical findings.