PEDICLED COMPARED WITH FREE TRANSVERSE RECTUS-ABDOMINIS MYOCUTANEOUS FLAPS IN BREAST RECONSTRUCTION

Two groups of patients who had undergone breast reconstruction with th e transverse rectus abdominis myocutaneous (TRAM) flap after modified radical or partial mastectomy were evaluated. The type of reconstructi on was either pedicled (n = 27, one of which bilateral) or free flap t ransfer (n = 11). In both groups there were both primary and secondary reconstructions. Flap complications were more common with the pedicle d TRAM flap. There were nine partial flap necroses in the pedicle grou p, but only one in the free flap group. The only flap loss was a pedic led flap. In the free flap group, revision of the anastomosis was requ ired in two patients. The free TRAM flap took longer to do than the pe dicled flap. In conclusion, the two procedures yield acceptable result s, but the free TRAM flap seems to be safer than the pedicled flap, th anks to the better blood supply from the inferior epigastric artery. I t also allows greater freedom and versatility in moulding the reconstr ucted breast.