Autogenous tissue reconstruction in the mastectomy patient. A critical review of 300 patients.

The transverse abdominal island flap operation was the method of breast reconstruction after mastectomy and in chest wall reconstruction in 300 patients from September 1980 to July 1986. In 58% (221 of 383 breast reconstructions), the breast mound was formed in a single operation and required no further revision. Only 18 reconstructed breasts required modification after 1 year. Symmetry was achieved without altering the opposite breast in 113 (52% of the 217 unilateral reconstructions). Complications included one total flap loss (0.3%) and 18 partial flap losses (6%). There was one lower abdominal hernia (0.3%) and two small defects in the upper anterior rectus sheath (0.8%). Lower abdominal wall laxity occurred in two patients (0.8%), one requiring repair. As expected, there was some loss of abdominal wall strength after reconstruction but this did not affect sports or work performance in over 90% of patients. Ninety-eight per cent of respondents (272 or 278) judged the operation worth their time and effort. This major operative procedure is indicated only in healthy patients.