[Breast reconstruction with pedicled TRAM flap (a retrospective study of 115 consecutive cases)].

PURPOSE OF THE STUDY

The purpose of this study is to analyse the advantages, disadvantages and results of the uni-pedicled TRAM flap.

PATIENTS AND METHOD

This retrospective study concerns 115 consecutive uni-pedicled TRAM flaps realised by two surgeons between 1994 and January 2007. These reconstructions were all realised for oncologic pathology and were either immediate or delayed surgery. Concerning the immediate reconstruction, a skin sparing mastectomy has been realised as often as possible for intraductal carcinomas and small invasive carcinomas. For the immediate reconstruction the study takes into account complications and oncologic recurrences with an average backward of 45 months.

RESULTS

The uni-pedicled TRAM flap offers a good reliability and the esthetics results are stable at long-term for immediate breast reconstruction and delayed breast reconstruction. The major complications are flap necrosis (12,2%) and parietal complications (6%). The recurrence rate after mastectomy and uni-pedicled TRAM flap is equivalent of the recurrence rate expected for mastectomy alone. There were never late diagnostic for recurrence after uni-pedicled TRAM flap. The esthetic improvement by surgery concerns the opposite breast for 31,3%, it was a mastopexy or reduction. The esthetic improvement of the TRAM flap concerns 14 patients (12,1%). The improvement of inframammary crease was the most frequent improvement (9/115-8%).

CONCLUSION

The TRAM flap uni-pedicled allows a delayed, immediate breast reconstruction or bilateral synchronised breast reconstruction. The long-term disadvantages are the abdominal complications and the impossibility to realise the same technique for a later contralateral reconstruction.