Immediate Breast Reconstruction Using Pedicled TRAM flap in Patients with Lower Midline Abdominal Scar: Is Zone I and III Sufficient?

Kim, Tae Gon; Chang, Hak; Lee, Taik Jong; Yoon, Ho Sung; Ahn, Sei Hyun

Abstract

In reconstruction of breast after mastectomy, one of the main objectives is to achieve acceptable appearance compared to the contralateral breast. For patients with midline abdominal scar. however, breast reconstruction using pedicled TRAM flap may have limitations in flap availability due to the reduced circulation across the scar. For this reason, zone II and zone IV is reluctantly resected during the course of reconstruction. Western literature have reported that vascular augmentation using bipedicled free TRAM, applying the supercharging or turbocharging procedure may be necessary to boost circulation. This may be true when a large flap bulk is needed. However, in case of Korean woman whose size of the breast is relatively small, we have found that using only half of a TRAM flap may produce sufficient bulk for reconstruction. We analyzed the relationship between weight of the resected breast tissue and body mass index (BMI, weight(kg) / (height(m))2) of the Korean breast cancer patients with lower midline abdominal scar. Mean weight of the resected breast tissue was 545.9 g with the average BMI was 23.4 kg/m2. The mean ratio of the resected breast mass to BMI was 21.7, which was proportional to BMI. Two of three patients whose ratio of the resected breast tissue mass to BMI were higher than 34.1 answered in the questionnare that the reconstructed one was smaller in size than the other side. When the ratio of the resected breast tissue mass to BMI is 29.8 or lower than this, a hemi-TRAM flap consisted with zone I and zone III provided sufficient tissue for reconstruction. In conclusion, using the BMI and weight of resected breast tissue mass, we can effectively predict the amount of TRAM flap needed for reconstruction.