Arch Plast Surg.  2012 Jul;39(4):376-383. 10.5999/aps.2012.39.4.376.

Outcome of Management of Local Recurrence after Immediate Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction

• Lee TJ
• Hur WJ
• Kim EK
• Ahn SH

• KMID: 2120692
• DOI: http://doi.org/10.5999/aps.2012.39.4.376

Abstract

BACKGROUND
No consensus has been reached regarding the outcome of management of local recurrence after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. This study demonstrated the presentation, management, and outcomes of local recurrence after immediate TRAM breast reconstruction.
METHODS
A comparison was conducted among 1,000 consecutive patients who underwent immediate breast reconstruction with a pedicled TRAM flap (TRAM group) and 3,183 consecutive patients who underwent only modified radical mastectomy without reconstruction (MRM group) from January 2001 to December 2009. The presentation, treatment, and outcome including aesthetics and overall survival rate were analyzed.
RESULTS
Local recurrences occurred in 18 (1.8%) patients (TRAM-LR group) who underwent TRAM breast reconstruction and 38 (1.2%) patients (MRM-LR group) who underwent MRM only (P=0.1712). Wide excision was indicated in almost all the local recurrence cases. Skin graft was required in 4 patients in the MRM-LR group, whereas only one patient required a skin graft to preserve the mound shape in the TRAM-LR group. The breast mound was maintained in all 17 patients that survived in the TRAM-LR group even after wide excision. The overall survival rate was 94.4% in the TRAM-LR group and 65.8% in the MRM-LR group (P=0.276).
CONCLUSIONS
Local recurrence after immediate TRAM flap breast reconstruction could be detected without delay and managed effectively by multiple modalities without reducing overall survival rates. Breast mound reconstruction with soft autologous tissue allowed for primary closure in most of the cases. In all of the patients who survived, the contour of their reconstructed breast remained.

Keyword

Breast neoplasms; Mammaplasty; Neoplasm recurrence, local

MeSH Terms

Breast
Breast Neoplasms
Consensus
Esthetics
Female
Humans
Mammaplasty
Mastectomy, Modified Radical
Neoplasm Recurrence, Local
Rectus Abdominis
Recurrence
Skin
Survival Rate
Transplants