Arch Plast Surg.  2018 Jul;45(4):333-339. 10.5999/aps.2017.01473.

A simple calculation for the preoperative estimation of transverse rectus abdominis myocutaneous free flap volume in 2-stage breast reconstruction using a tissue expander

• Kono H
• Ishii N
• Takayama M
• Takemaru M
• Kishi K

• KMID: 2418244
• DOI: http://doi.org/10.5999/aps.2017.01473

Abstract

BACKGROUND
Flap volume is an important factor for obtaining satisfactory symmetry in breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) free flap. We aimed to develop an easy and simple method to estimate flap volume.
METHODS
We performed a preoperative estimation of the TRAM flap volume in five patients with breast cancer who underwent 2-stage breast reconstruction following an immediate tissue expander operation after a simple mastectomy. We measured the height and width of each flap zone using a ruler and measured the tissue thickness by ultrasound. The volume of each zone, approximated as a triangular or square prism, was then calculated. The zone volumes were summed to obtain the total calculated volume of the TRAM flap. We then determined the width of zone II, so that the calculated flap volume was equal to the required flap volume (1.2×1.05×the weight of the resected mastectomy tissue). The TRAM flap was transferred vertically so that zone III was located on the upper side, and zone II was trimmed in the sitting position after vascular anastomosis. We compared the estimated flap width of zone II (=X) with the actual flap width of zone II.
RESULTS
X was similar to the actual measured width. Accurate volume replacement with the TRAM flap resulted in good symmetry in all cases.
CONCLUSIONS
The volume of a free TRAM flap can be straightforwardly estimated preoperatively using the method presented here, with ultrasound, ruler, and simple calculations, and this technique may help reduced the time required for precise flap tailoring.

Keyword

Breast; Diagnostic imaging; Mammaplasty; Mammary glands; Mastectomy

MeSH Terms

Breast Neoplasms
Breast*
Diagnostic Imaging
Female
Free Tissue Flaps*
Humans
Mammaplasty*
Mammary Glands, Human
Mastectomy
Mastectomy, Simple
Methods
Rectus Abdominis*
Tissue Expansion Devices*
Ultrasonography