221 Breast Reconstructions in 12 years – How to select options among Implants, Pedicled TRAM, Free TRAM and DIEP flaps?

Abstract

This is a report of 221 breast reconstructions performed after total mastectomy for the treatment of breast tumour in Kwong Wah Hospital between 1991 and 2003. In these 12 years, there was a trend of increasing options among various methods of breast reconstructions. Three distinct periods: 1991–1994, 1994–2001, and 2001–03 were categorized. In the first period (91–94), 27 pedicled TRAM flap had been the workhorse for the postmastectomy reconstruction. In the second period (1994–2001), pedicled TRAM flap had dropped to 41% (52/126) while free TRAM flap that were transferred for larger breasts became equally important 45% (57/126). Latissimus Dorsi flap with mammary implant (4/126) was also used in selected patients who accepted foreign body implantation. In the third period (01–03), the concept of functional preservation of the rectus abdominus muscle had brought in a major change in autologous tissue transfer in breast reconstruction. Thereafter, a series of 43 perforator flaps (DIEP: Deep Inferior Epigastric Perforator flap) had been performed with a high success rate (100%). In the same period, 25 other options (37%) continued to be selected for appropriate patients. In the selection among various options, breast size and donor flap matching, postoperation radiation and foreign body fibrosis, donor site morbidity and free flap success rate were the major determining factors.