Howard Michael A, Polo Kristen, Pusic Andrea L, Cordeiro Peter G, Hidalgo David A, Mehrara Babak, Disa Joseph J
Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Plast Reconstr Surg. 2006 Apr 15;117(5):1381-6. doi: 10.1097/01.prs.0000208116.86765.4a.
The transverse rectus abdominis musculocutaneous (TRAM) flap is the standard in autologous breast reconstruction. The management of local recurrence of breast cancer after TRAM flap breast reconstruction has not been well described. The purpose of this study was to examine the incidence of local recurrence of breast cancer after TRAM flap breast reconstruction, evaluate treatment modalities, and determine outcomes in such cases.
A retrospective review was conducted of all patients who underwent immediate breast reconstruction with a free or pedicled TRAM flap over a 15-year period. Those patients who experienced local breast cancer recurrence were identified. A subset of complete skin-sparing mastectomy patients was also identified for review.
From 1987 to 2002, 419 TRAM flap breast reconstructions were performed in 395 patients. Thirty-four (9 percent) were complete skin-sparing mastectomy using a periareolar mastectomy incision only. The mean follow-up time in this study was 4.9 years (range, 1 to 14.7 years). Local recurrence occurred in 16 of 419 patients (3.8 percent), with a mean time to local recurrence of 1.6 years (range, 0.2 to 7.0 years). There were no local recurrences seen in patients following complete skin-sparing mastectomy. Treatment of local recurrence included excision, chemotherapy, radiotherapy, and bone marrow transplant. Only three of the 16 patients (19 percent) required removal of the entire TRAM flap to manage local breast cancer recurrence. Nine of 16 patients (56 percent) with local recurrence died of disease at a mean of 1.2 years after the development of recurrence.
Long-term follow-up demonstrated a local recurrence rate after TRAM flap breast reconstruction similar to that reported in the literature. Local recurrence was effectively managed with surgical excision of the involved tissues, chemotherapy, and/or radiation therapy. Removal of the entire TRAM flap was only necessary in the setting of multifocal recurrence or involvement of the flap pedicle with disease. The risk of local recurrence was not increased following complete skin-sparing mastectomy.
横行腹直肌肌皮瓣（TRAM瓣）是自体乳房重建的标准术式。TRAM瓣乳房重建术后乳腺癌局部复发的处理方法尚未得到充分描述。本研究的目的是探讨TRAM瓣乳房重建术后乳腺癌局部复发的发生率，评估治疗方式，并确定此类病例的治疗结果。
对15年间所有接受游离或带蒂TRAM瓣即刻乳房重建的患者进行回顾性研究。确定那些经历了局部乳腺癌复发的患者。还确定了一组保乳根治术患者进行回顾。
1987年至2002年，395例患者共进行了419例TRAM瓣乳房重建。34例（9%）仅采用乳晕周围乳房切除术切口进行了保乳根治术。本研究的平均随访时间为4.9年（范围1至14.7年）。419例患者中有16例（3.8%）发生局部复发，局部复发的平均时间为1.6年（范围0.2至7.0年）。保乳根治术后患者未见局部复发。局部复发的治疗包括切除、化疗、放疗和骨髓移植。16例患者中只有3例（19%）需要切除整个TRAM瓣来处理局部乳腺癌复发。16例局部复发患者中有9例（56%）在复发后平均1.2年死于疾病。
长期随访显示，TRAM瓣乳房重建术后的局部复发率与文献报道相似。通过手术切除受累组织、化疗和/或放疗可有效控制局部复发。仅在多灶性复发或瓣蒂受累的情况下才需要切除整个TRAM瓣。保乳根治术后局部复发风险并未增加。
