Epidermal Inclusion Cyst after Breast Reconstruction with TRAM Flaps

Abstract

Breast reconstruction with TRAM flaps has becomean increasingly common surgical procedure amongbreast cancer patients who undergo a mastectomy (1).TRAM flap reconstruction involves the transfer of lowerabdominal skin and subcutaneous fat to the chest defectat the mastectomy site (2). In this procedure, the epider-mal inclusion cyst can be developed at the surgical site ifthe de-epithelized portion of buried skin flaps retains theepithelial elements. This epidermal inclusion cyst,which can be mistaken for a recurrent cancer, may leadto a false positive finding on a mammogram.To our knowledge, reports on epidermal inclusioncysts after breast reconstruction surgery have not beenpreviously described in the literature. So, we report ourexperience of an epidermal inclusion cyst in a patientwho underwent a total mastectomy with breast recon-struction and TRAM flaps.Case ReportA 50-year-old woman was admitted to our hospital fora follow-up mammography. She underwent a left totalmastectomy and reconstruction with TRAM flaps fortreatment of the ductal carcinoma in situ, about 6-months prior. The mammography showed findings sug-gesting that the postoperative change and an oval-shaped, circumscribed partially indistinct marginal iso-dense mass at the 2 o’clock position of the left breast(Fig. 1A). The mass was believed to be benign, such asfat necrosis or benign granuloma, so the patient was rec-ommended to receive follow-up mammography 6-months later.The 6 month follow-up showed an increase in the sizeof the previously detected mass at the 2 o’clock positionfrom about 10 mm to 13 mm in diameter (Fig. 1B). Onultrasonography, the lesion was located in the peripher-al portion of reconstructed breast, adjacent to the inci-