An analysis of breast cancer surgery after free transverse rectus abdominis myocutaneous (TRAM) flap reconstruction

BACKGROUND: Breast reconstruction is currently offered on a more routine ba sis to patients after mastectomy for breast cancer. This paper analyzes the outcomes of breast cancer surgery, and the results and effects of breast r econstruction using free TRAM flaps. METHODS: A retrospective review of 75 consecutive patients who had free tra nsverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction aft er breast cancer surgery was performed. A total of 92 free TRAM flaps were performed on 75 patients in Victoria, British Columbia, from January 1992 t o May 1999. Thirty-three patients (44%) underwent primary breast cancer sur gery and an immediate reconstruction (7 bilateral and 27 unilateral) and 42 patients (56%) had delayed reconstruction (10 bilateral and 32 unilateral) . RESULTS: Twenty- one patients (28%) had stage 0 disease, 20 (26.7%) had sta ge I disease, 17 (22.7%) had stage IIA disease, 12 (15%) had stage IIB dise ase, and 4 (5.3%) had stage IIIA disease. In 1 patient the stage of disease was unknown. The mean patient age was 49.4 years (range 33 to 73). Of the patients undergoing immediate reconstruction 3 had postoperative chemothera py and 1 had postoperative radiotherapy. Three patients had combined chemor adiotherapy. In none of these cases was the adjuvant therapy delayed by the reconstructive surgery. Overall mean follow-up time from cancer diagnosis was 56.8 months and from the time of TRAM flap reconstruction, 36.7 months. To date, 5 recurrences have been detected (6.6%). Mean time between recons truction and detection of recurrence was 22.8 months. Detection of recurren ce was achieved clinically and was not impaired in any of the cases by the presence of the free flap. Patient satisfaction was assessed via a telephon e survey, with 93% of patients pleased with the cosmetic results of their s urgery. CONCLUSIONS: For those patients with breast cancer requiring mastectomy, fr ee TRAM flap reconstruction is a safe, cosmetically acceptable surgical alt ernative that impairs neither effective breast cancer surgery nor detection of recurrent disease. (C) 2000 by Excerpta Medica, Inc.