Prospective evaluation of late cosmetic results following breast reconstruction: II. TRAM flap reconstruction

Although it is thought that transverse rectus abdominis muscle (TRAM) flap breast reconstruction produces excellent cosmetic results that are maintain ed over the long term, there is little objective evidence in the literature to support this. One hundred seventy-one consecutive patients who underwen t TRAM flap reconstruction were prospectively analyzed over an 8-year perio d to assess their morbidity and late cosmetic outcome. The early patient complication rate (<2 months) was 37.4 percent, the late hernia and fat necrosis rates (> 2 months) were 8.8 and 13.5 percent, respe ctively, and the contralateral symmetrization rate was 33.9 percent. The co smetic results were evaluated prospectively using an objective five-point g lobal scale. Each patient was scored at each visit once surgery was complet ed. Follow-up continued until a flap was lost, a patient died, or the point of last patient contact was reached. Six patients died during the study. T he actuarial percentage cosmetic outcome remained stable during the study p eriod, with an acceptable result in 96.4 percent of patients at 2 years and in 94.2 percent of patients at 5 years. Only five patients in this series obtained poor cosmetic outcomes, with three due to substantial flap necrosi s and two because of poor flap design. Two free TRAM flaps were also lost. Log-rank analysis revealed that neither patient age nor timing of surgery s ignificantly affected the cosmetic outcome. Single pedicle and superchanged (single pedicle) TRAM flaps produced slightly better results than bipedicl e and free TRAM flaps. In this prospective longitudinal study, TRAM flap re constructions were shown to produced aesthetically pleasing results. Moreov er, with long-term follow-up, it was demonstrated that these reconstruction s maintained their stability.