Breast reconstruction with single-pedicle TRAM flap in breast cancer patients with low midline abdominal scar.

Jun-Dong Wu,Wen-He Huang,Guo-Jun Zhang,Si-Qi Qiu,Fan Zhang,Yong-Qu Zhang,Cui-Ping Guo,Li-Fang He

doi:10.1038/srep29580

Jun-Dong Wu, Wen-He Huang + Show 6 more

Open Access

https://doi.org/10.1038/srep29580

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Abstract

Breast reconstruction with transverse rectus abdominis myocutaneous (TRAM) flap is challenging in patients with low midline abdominal scar. In this study, we aimed to investigate the clinical feasibility of immediate breast reconstruction using single-pedicle TRAM (SP-TRAM) flaps in patients with low midline abdominal scar. There were 4 strict selection criteria: 1) presence at least 3 perforators on the pedicle side; 2) perforators with regional average flow velocity of >20 cm/s; 3) upper edge of the abdominal scar at least 4 cm from the umbilicus; and 4) scar age >1 year. Eight breast cancer patients with low midline abdominal scar (scar group) and 20 without (control group) underwent immediate breast reconstruction with SP-TRAM flaps consisting of zone I and III and zone II tissues. Flap complications, donor-site complications, and cosmetic results were compared between the two groups. All flaps survived and both groups presented similar flap and donor site complications, including fat necrosis, seroma, hematoma, infection, delayed wound healing, and abdominal hernia, and patients in both groups had similar aesthetic results (p > 0.05). Thus, the study demonstrated that breast reconstruction using SP-TRAM flap was a safe approach in carefully selected patients with low midline abdominal scar.

Highlights

Demographics Mean age body mass index (BMI) Diabetes Smokers NAC PR Histology DCIS LCIS IDC ILC mucinous Medullary Histological grade 1 2 3 In situ carcinoma pTNM stage 0 I II III Molecular subtype Luminal A Luminal B1 Luminal B2 HER-2 overexpression Triple negative
There were no significant differences in age, body mass index (BMI), smoking history, diabetes mellitus, and neo-adjuvant chemotherapy or preoperative radiotherapy between the scar and control groups, and no significant difference between groups in pathological characteristics (Table 1)
Abdominal scar does not preclude the use of the Transverse rectus abdominis myocutaneous (TRAM) flap, but it may determine how much tissue is available for use in the breast reconstruction[2], especially in patients with low midline abdominal scar[2,7,11]

Summary

Objectives

We aimed to investigate the clinical feasibility of immediate breast reconstruction using single-pedicle TRAM (SP-TRAM) flaps in patients with low midline abdominal scar

Methods

Results

Conclusion