Immediate Breast Reconstruction with Transverse Rectus Abdominis Myocutaneous Free Flap after Skin Sparing Mastectomy

Chung, Ji Yong; Park, Bong Kweon; Ahn, Hee Chang

Abstract

The free TRAM flap has been accepted as an excellent method of autogenous tissue breast reconstruction. In addition, oncologic surgeons and plastic surgeons are trying to perform skin preserved mastectomy to get more esthetically better result in breast reconstruction. Breast tissue and mass would be removed through circumareolar incision, and axillary lymph node dissection could be carried through separate incision on axilla. This paper represents our experiences and results of immediate breast reconstruction with transverse rectus abdominis myocutaneous free flap after skin-sparing mastectomy. From 1999 to 2001, the flaps were utilized in 15 patients to reconstruct the new breast by free TRAM flap after skin sparing mastectomy. The mean age of the patients were a 42-years-old. Location of cancer was on the right breast in 12 cases, left breast in 2 cases and bilateral breasts in 1 case. We chose the thoracodorsal artery and its venae commitantes as recipient vessels, and deep inferior epigastric vessels as donor vessels.All flaps survived completely. There has been no flap necrosis, hematoma, and seroma. The results have been functionally and esthetically satisfactory. There are several advantages in this technique comparing with similar breast reconstruction of routine modified radical mastectomy. This technique leaves less scar and allows better preservation of sensation, aesthetically more natural shape, and better symmetry in reconstructed breast with free TRAM flap afterskin sparing-mastectomy.