IMMEDIATE TRAM FLAP BREAST RECONSTRUCTION - 128 CONSECUTIVE CASES

The purpose of this article is to determine whether or not the transve rse rectus abdominis musculocutaneous (TRAM) flap procedure is a pract ical operation for immediate breast reconstruction. Our series reports 128 consecutive patients who underwent immediate breast reconstructio n with the TRAM flap from 1985 to 1990. Of these patients, 86 underwen t conventional TRAM, while 40 underwent free TRAM breast reconstructio n. Two-thirds of the patients underwent bilateral breast reconstructio n. Comparison within this series of the free TRAM versus the conventio nal TRAM flap revealed improved statistics with regard to the free TRA M flap in a shorter hospitalization time and a decreased incidence of fat necrosis. There is no evidence to date that there is an increased chance of local recurrence with immediate breast reconstruction in thi s series, and chemotherapy was delayed in a single patient because of healing problems after immediate reconstruction. Operative times and t he complication rate seem to be improving as compared with other serie s previously reported. The TRAM procedure, particularly the free TRAM procedure, is a primary choice for immediate breast reconstruction aft er mastectomy.