Pedicled TRAM Research Articles

The Partial Removal of Rectus Abdominis Muscle Inserting into Ribs in Ipsilateral Pedicled TRAM Flap for Breast Reconstruction.

The purpose of this study was to introduce a new surgical technique for pedicled TRAM flap that removes a part of the rectus abdominis muscle inserting into ribs, and to analyze this technique in comparison with classical pedicled TRAM flap. A retrospective review of patient charts from May 2006 to February 2016 was performed. The patient group that underwent the removal of the part of the rectus abdominis that inserts into the thorax (partial muscle resection; PMR group) was compared with the group that did not undergo this muscle resection (Classical group). The complications and aesthetic effects of surgery between the two groups were analyzed. There were 34 patients in the classical group and 28 in the PMR group. There were no significant differences in postoperative complications between these two groups. The rates of fat necrosis were 32.1% in the PMR group and 36.1% in the classical group. The postoperative aesthetic outcome of the inframammary fold showed no significant differences in outcome between the classical and PMR groups. However, all items received higher scores in the PMR group. The authors' new surgical method was associated with a positive cosmetic effect of improving inframammary fold aesthetics and could thus represent a new option for pTRAM breast reconstruction.

Risk Factors and Complications of Abdominally Based Breast Reconstruction: A Comparative Analysis of 13,587 Patients

INTRODUCTION: Autologous breast reconstruction is most commonly abdominally based. Deep inferior epigastric perforator (DIEP), pedicled transverse rectus abdominis musculocutaneous (pTRAM), and free transverse rectus abdominus musculocutaneous (fTRAM) flaps subject a patient to significant abdominal wall morbidity. A comparative analysis of DIEP, pTRAM, and fTRAM flaps for breast reconstructions is necessary to understand major risk factors for adverse outcomes. The purpose of this study is to determine the safety and advantages of a DIEP vs pedicled TRAM vs fTRAM flap for breast reconstruction. METHODS: Admitted patients with a DIEP or pTRAM or fTRAM breast flap were analyzed using the National Inpatient Sample database, 2005–2014. Demographics, clinical data, and outcomes were collected. The relationship between mortality and predictors was assessed using a stratified analysis and multivariable logistic regression model. RESULTS: A total of 13,587 patients with DIEP, fTRAM, or pTRAM breast flap reconstruction were analyzed. Patients with a fTRAM were the most likely to experience a complication, followed by DIEP and then pTRAM. The most common complication for all groups was hemorrhage, most common in DIEP flaps. However, DIEP flap reconstructions were performed with shorter hospital stays. This group also exhibited the highest rates of thrombosis compared with pTRAM and fTRAM flaps. Conversely, the DIEP group had the lowest rates of postoperative infections, dehiscence, and pulmonary embolism. There were no significant differences in flap type used in the breast reconstruction between survived and deceased patients. CONCLUSION: These data support the DIEP flap as the chosen flap for autologous breast reconstruction in postmastectomy patients.

Breast reconstruction with the ipsilateral pedicled tram flap in breast cancer patients having the low abdominal scars

Objectives: To assessement outcome of breast reconstruction with the ispilateral pedicled TRAM flap in breast cancer patient having the low abdominal scars. Methods : The pedicled TRAM flap breast reconstruction were performed in 48 patients after nipple sparing mastectomy as well as modified radical mastectomy from 2017 - 2019 at Hue Central Hospital. Results: There is 16/48 (33.3%) patient who have the low abdominal scars and 100% in which were operated by the ispilateral pedicled TRAM flap in breast reconstruction, part I, III of TRAM was using for 15/16 patients. Compare to the contralateral pedicled TRAM flap, the ispilateral pedicled TRAM flap have a shorter in surgical time (under 180 minutes) and time staying hospital (under 10 days). Most of them having the aesthetic results and satisfied with immediate or delay breast reconstruction. The rate of complication was 12.5%, no finding the severe complications of reconstruction in the total flap necrosis and hernia or bulge in this study. Conclusion: The ispilateral pedicled TRAM flap was a safe as well as contralateral pedicled TRAM flap and reliable procedure for breast cancer patient having the low abdominal scars. Key words: TRAM flap, breast cancer, breast reconstruction.

National Disparities in Autologous Breast Reconstruction

PURPOSE: Autologous breast reconstruction has evolved from more morbid procedures that sacrificed the patient’s abdominal muscle (the TRAM or transverse rectus abdominus muscle flap) to more elegant autologous reconstructions termed “perforator” flaps that spare fascia and muscle to harvest only the adipose tissue. Commercial insurers have recognized the higher technical demand for perforator flaps relative to other autologous reconstructions by creating separate procedural codes with significantly higher professional fees. This study examined whether a perforator flap procedure code unavailable with Federally issued Medicare or Medicaid disproportionally incentivizes perforator flaps among the commercially insured and, subsequently, patients from a higher socioeconomic status. METHODS: Autologous reconstructions performed between 2008 and 2014 were reviewed from the National Inpatient Sample using the ICD-9-CM procedure codes 85.72, 85.73, 85.74, 85.75, and 85.76. Extracted variables included age, race, comorbidities, hospital type, hospital region, insurance payer type, and median household income quartile. Autologous breast reconstruction was subdivided into microvascular perforator flaps (85.74, 85.75, 85.76), microvascular TRAM flaps (85.73), and pedicled TRAM flaps (85.72). Demographics, comorbidities, and access to care were compared between cohorts by chi-squared and ANOVA tests. A logistic regression comparing microvascular reconstructions only was created to predict the effects of insurance, geography, income quartile, and race on the likelihood of perforator flap reconstruction while controlling for age and comorbidities. RESULTS: After querying and weighting National Inpatient Sample data, 33,246 microvascular perforator flap breast reconstructions, 16,804 microvascular TRAM flap reconstructions, and 16,918 pedicled TRAM flap reconstructions were compared. The majority of patients undergoing autologous reconstruction were Whites (64.1%), with a mean age of 51.1 years. Patients receiving microvascular perforator flaps had fewer total comorbidities than patients receiving microvascular TRAM (P < 0.001) or pedicled TRAM (P = 0.003) flaps. Perforator flaps were significantly more likely among the commercially insured (perforator flap: 85.8% versus microvascular TRAM: 75.9% versus pedicled TRAM: 75.0%, P < 0.001), while TRAM flaps were more likely among patients with Medicare or Medicaid (perforator flap: 14.2% versus microvascular TRAM: 24.1% versus pedicled TRAM: 25.0%, P < 0.001). Patients of higher income quartiles were significantly more likely to receive perforator flap autologous reconstruction (P < 0.001). When comparing microvascular reconstruction, logistic regression revealed an odds ratio of 1.72 (P < 0.001) for perforator flaps among the commercially insured when compared with patients with Medicare or Medicaid. Income trends paralleled insurance status. When compared with the lowest income quartile, the second quartile had an odds ratio of 1.11 (P = 0.003) for perforator flap reconstruction, the third 1.07 (P = 0.029), and the fourth 1.36 (P < 0.001). Compared with rural locations, urban nonteaching hospitals had an odds ratio of 2.42 (P < 0.001) for perforator flap reconstruction and urban teaching hospitals had an odds ratio of 4.08 (P < 0.001). Asian patients had a higher odds ratio of receiving perforator flaps than White patients, with an odds ratio of 1.16 (P = 0.010). Black and Hispanic patients had comparable rates as White patients, with odds ratios of 0.97 and 0.95, respectively (P = 0.342, P = 0.192). CONCLUSIONS: Reimbursement incentives disproportionally favor perforator flap autologous reconstruction among the commercially insured. Differences across insurance status exaggerate already existing disparities in breast reconstruction across socioeconomic status.

Is Pregnancy Following a TRAM or DIEP Flap Safe? A Critical Systematic Review and Meta-analysis.

Previous data were not conclusive on the safety of gestation in patients whose abdominal flaps were earlier harvested. We performed a meta-analysis to evaluate the abdominal wall complications and birth mode of pregnancy in post-TRAM or post-DIEP harvested individuals. A literature search was performed using the PubMed, Embase, Scopus, and Google scholar database. Heterogeneity was statistically analyzed, and random effect models were applied. Publication bias was assessed by funnel plot. We included 25 papers that captured 56 patients giving birth to 69 healthy babies after elevation of abdominally based flaps, with a pooled abdominal complication rate of 0.00-0.09. The complication incidence in TRAM group was 0.01 (95% CI = [0.00-0.14%]) while 0.00 in the DIEP group (95% CI = [0.00-0.26%]). Discrepancies in incidence following unilaterally or bilaterally based TRAM flaps, following free or pedicled TRAM flaps, following primary sutured or mesh strengthened fascia, following MS free TRAM or conventional free TRAM could not be calculated as statistically significant. TRAM group and DIEP group patients had identical birth modes. The present meta-analysis did not detect evidence that abdominal walls with the prior harvest of abdominal flaps could affect the process of pregnancy or contraindicate vaginal delivery. No abdominal hernia or bulge occurred with post-DIEP pregnancies. However, such conclusions need to be substantiated by larger sample studies. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Risk factors for delayed autologous breast reconstruction using pedicled TRAM and latissimus dorsi flaps

The purpose of this study was to compare outcomes between patients submitted to pedicled transverse rectus abdominis musculocutaneous (pTRAM) and latissimus dorsi musculocutaneous (LD) flaps for breast reconstructions and to investigate potential risk factors for complications in autologous reconstruction. A retrospective review of delayed autologous breast reconstructions by five surgeons in a single centre was performed. Between 2014 and 2018, 215 women underwent unilateral breast reconstruction with pTRAM or LD flaps. Patient demographics were analyzed including age, body mass index (BMI), smoking, diabetes mellitus, hypertension, radiotherapy and chemotherapy. Patient medical records were reviewed for the length of hospital stay (LOS), volume and duration of breast drainage, volume and duration of donor area drainage, major immediate complications, early and late complications, reinterventions, readmittances and reinterventions for late complications. LD reconstruction was associated with longer length of stay, duration of breast and donor area drainage and a higher prevalence of seroma in the donor area (37.8% vs 6.5%). pTRAM breast reconstruction had higher rates of pulmonary embolism and late complications. Age over 60 was a risk factor for immediate major complications. Smoking was associated with increased early complications. Late complications increased when the BMI was above 30. Autologous breast reconstruction with pTRAM and LD flaps is safe and offers a long-standing pleasant aesthetic shape. The results of this study show that age over 60, BMI > 30 and smoking increase the complications rate. These patients should be informed about their higher profile risks before proceeding with the reconstruction. Level III, risk/prognostic study.

Altering effects of caffeic acid phenethyl ester (CAPE) and ischemia/reperfusion injury: an experimental study in a rat TRAM flap model

Many studies have been performed since the discovery of ischemia-reperfusion injury (I/R) to find substances that reverse its effects on flaps. However, because of minor or major side effects these substances are mostly failed to be put in clinical practice. In this study, the mitigation effects of caffeic acid phenethyl ester (CAPE) were investigated for its protective effects on flap necrosis in a rat model. Forty-two randomized male Sprague-Dawley rats weighing between 250 and 300 g were assigned to the regular flap (G1) (n = 14), ischemic flap (G2) (n = 14), and ischemic flap + CAPE (G3) (n = 14) groups. Bilateral pedicled TRAM flaps were designed for the first seven rats of each group,; bilateral-free TRAM flaps were designed for the remaining rats in each group and referred as subgroup 1 and 2 (S1 and S2), respectively. In G1, flaps were returned to their original locations without clamping or injection. In G2 and G3, a 2-h ischemia was performed. Before the ischemic process, intraperitoneal saline and CAPE solution was administered intraperitoneally in the second and third groups, respectively. On day 7 after the operation, all flaps were harvested and subjected to biochemical (malondialdehyde, superoxide dismutase, and catalase levels) and histological examinations (hematoxylin & eosin, Mallory-Azan, anti-VEGF, anti-BAX, anti Bcl-2, and anti-iNOS stainings), respectively. Enzyme levels and the Verhofstadt scores showed a statistically significant difference in flaps among the groups. Less injury was noted in G3 than in G2 (p < 0.01). In this experimental model, CAPE was effective in protecting tissues against ischemia-reperfusion injury. Level of evidence: no ratable

The island-type pedicled TRAM flap: Improvement of the aesthetic outcomes of breast reconstruction

The pedicled transverse rectus abdominis myocutaneous flap (TRAM) remains an effective and widely-used method for breast reconstruction despite well-documented donor-site morbidity. We present the island-type pedicled TRAM flap as a way to obtain better and more reliable outcomes in breast reconstruction. A retrospective chart review of patients who underwent breast reconstruction with an island-type pedicled TRAM flap was performed. Patient demographics and complications were reviewed. In the island-type pedicled TRAM flap, we transversely resected the upper ipsilateral rectus muscle surrounding the origin of the superior epigastric vessels, preserving only a 1-cm muscle strip including the vascular pedicle to prevent epigastric bulging and inframammary fold (IMF) disruption. The flap was turned over into the ipsilateral breast pocket. The IMF was repaired except for the portion where the pedicle was placed. From January 2013 to November 2017, 88 patients underwent surgery using the island-type pedicled TRAM flap. The etiology of the defect was breast cancer with mastectomy in 86 cases, and paraffinoma in two cases. Seventy-seven patients underwent unilateral reconstruction, and 11 patients underwent bilateral reconstruction. Minor fat necrosis occurred in eight cases. Mild inframammary or epigastric bulging was observed in five cases, and neither partial nor total flap necrosis was observed. The aesthetic outcome of the IMF was evaluated in 55 cases, and 53 cases received good overall scores. Although the island-type pedicled TRAM flap is technically challenging because careful dissection and pedicle identification is required, it can provide more reliable and better aesthetic results without an increased risk of vascular compromise.

Evaluation of Delayed Pedicled TRAM Flap for Breast Reconstruction in High Risk Patients

Evaluation of Delayed Pedicled TRAM Flap for Breast Reconstruction in High Risk Patients

1995 Single Port Access Total Laparoscopic Hysterectomy and Bilateral Salpingo-Oophorectomy after Transverse Rectus Abdominis Myocutaneous Flap (TRAM) in Patient with Breast Cancer

Study Objective Abdominal wall anatomy can be altered after transverse rectus abdominis myocutaneous flap (TRAM) procedure in patient with breast cancer and the umbilicus may be distorted. For this reasons, laparoscopic gynecologic surgery is difficult procedure including proper port placement, the knowledge of the residual blood supply to the abdominal wall and umbilicus. We present our experience performing single port access total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (SPA-TLH BSO) on a woman after TRAM surgery. Design N/A Setting N/A Patients or Participants N/A Interventions 53 years old woman who were diagnosed with breast cancer got left modified radical mastectomy followed by the breast mound reconstruction with contralateral pedicled TRAM flap three years ago. she took two cycles of chemotherapy after surgery. Since then, she has been taking tamoxifen and referred to Gynecologic oncology department for growing uterine myoma. 8 × 7 cm sized uterine myoma on transvaginal sonography was observed. The patient was recommended with hysterectomy and bilateral salpingo-oophorectomy. Transumbilical SPA TLH and BSO were performed after confirming the pathway of the vessel of pedicle by Abdominal-pelvic CT. Measurements and Main Results After making of altered anatomy of abdominal muscle flap, self designed single port system was made using the wound retractor and a surgical glove on umbilicus. We did not make additional port placement to avoid damage of abdominal wall with previous TRAM procedure. patient underwent successful SPA TLH and BSO transumbilical incision for single port placement. There was no complication during operation. Conclusion Single port access laparoscopic surgery is feasible in women after TRAM reconstruction. Knowledge of anatomic and physiologic variations related to the TRAM procedure is necessary in planning a safe operation.

How Do We Raise the Bar in Autologous Breast Reconstruction? The Use of Progressive Tension Sutures for Donor Site Closure

BACKGROUND: The abdomen is the most common location from which tissue is harvested for autologous breast reconstruction.1 The evolution from musculocutaneous flaps to muscle-sparring perforators flaps has decreased donor site complications such as abdominal bulge and hernia; however, complications remain. The development of progressive tension suture placement for donor site closure has the potential to decrease complications and increase the esthetics of the abdomen after breast reconstruction.2 PURPOSE: To present our institutional experience using progressive tension sutures for a tensionless closure of the donor site to improve outcomes and optimize abdominal donor site esthetics. METHODS: A retrospective cohort study was conducted over a 2-year period. Sixty-six consecutive patients who underwent abdominally based autologous breast reconstruction were divided into an experimental group (36 patients), in which the donor site was closed using progressive tension sutures, and a control group (31 patients), in which the donor site was closed without the use of this technique. A comparison between both groups was conducted in terms of demographic characteristics, perioperative variables, and donor site–related postoperative complications. RESULTS: No significant differences were found between the 2 groups in terms of demographic characteristics including age, body mass index, smoking status, comorbidities, and previous abdominal surgery (P > 0.05). No significant differences were noted with respect to unilateral versus bilateral donor sites, operative times, and length of hospital stay (P > 0.05). With regard to donor site complications, the wound dehiscence rate was significantly higher for the control group (27.8% versus 6.5; P = 0.023). No differences were noted in terms of infection, seroma formation, hematoma formation, abdominal bulge, or abdominal hernia rates between the 2 groups. CONCLUSION: In the cohorts of patients analyzed, the use of a tensionless technique for the closure of the donor site after an abdominally based autologous breast reconstruction decreased the rates of donor site wound dehiscence. Seroma and hematoma formation rates remained the same across both groups. REFERENCES: 1. Agarwal J, Tatro E, Kwok A, et al. Immediate unilateral breast reconstruction using abdominally based flaps: analysis of 3,310 cases. J Reconstr Microsurg. 2018. 2. Lee BT, Agarwal JP, Ascherman JA, et al. Evidence-based clinical practice guideline: autologous breast reconstruction with DIEP or pedicled TRAM abdominal flaps. Plast Reconstr Surg. 2017;140:651e–664e.

Delayed Breast Reconstruction Evaluation Following Mastectomy Utilisting Transverse Rectus Abdominis Myocutaneous Flap Versus Latissimus Dorsi Flap Reconstruction

During the last century, breast reconstruction after mastectomy has become an important part of comprehensive treatment for patients who have breast cancer. comparison patients after delayed breast reconstruction Following Mastectomy Utilisting transverse Rectus Abdominis Myocutaneous Flap Versus Latissimus Dorsi Flap Reconstruction due to breast cancer. This study include 22 patients with surgical history of modified radical mastectomy and operated for delayed breast reconstruction with pedicled TRAM flap and pedicled LD flap . comparative study between to type of flap in many items such as operative time (in minutes), length of hospital stay (in days), post operative complications and hospital readmission, patient satisfaction. latissimus dorsi flap however its limitation of patient selection is low than pedicled tram in hostipal stay and flap necrosis without major doner site complication of abdominal bluging and with low incidence of systemic complication of DVT and pulmonary embolism. TRAM procedure is good for patient adequate lower abdominal wall tissue who desire abdominoplastic result beside breast reconstruction.

A New Concept of Interval TRAM for Immediate Breast Reconstruction in Obese Women.

Performing pedicled TRAM in obese women carries risk of flap loss or native breast envelop necrosis. Our technique depends on performing total flap delay at the same setting with mastectomy with flap suture in situ to be followed 1week later by flap transfer. This study included 24 operable women who were candidates for skin sparing or modified radical mastectomy. In one case, delay was only done and followed by mastectomy and flap transfer. In later experience, delay plus mastectomy was done first and followed later by flap transfer. Operative data and postoperative complications were recorded. The mean BMI was 37 ± 2.75. The mean total operative time was 200 ± 20.37. The mean total hospital stay was 9.1 ± 3.35days. The mean total volume of blood loss was 380 ± 82.33ml. Breast envelop necrosis was encountered in four cases; three of them were replaced by the TRAM skin. There was no total flap loss while partial loss was recorded in five cases. Fat necrosis occurred in eight cases. Most of mastectomy bed and abdominal complications were in average. Most of cases showed satisfactory esthetic outcome. Our new concept of "Interval TRAM" enables safe immediate breast reconstruction with pedicled TRAM in obese women and ensures presence of a skin pack up for the native breast envelop skin. We recommend this technique in every obese female who undergoes skin sparing mastectomy with immediate pedicled TRAM flap reconstruction.

Reconstrucción mamaria con colgajo musculocutáneo de recto abdominal con isla transversa de piel (TRAM): Experiencia de 12 años en Hospital El Pino

Objectives: To analyze the results of breast reconstruction with musculocutaneous flap of the rectus abdominis with transverse skin island (TRAM) in the Service of Surgery of El Pino Hospital. Materials and Methods: Retrospective study of patients undergoing mastectomy for breast cancer and subsequent reconstruction with pedicled TRAM flap in the last 12 years (2005-2017). Results: 12 mammary reconstructions were performed, 6 were with pedicled TRAM flap. The majority of patients received adjuvant treatment with radiotherapy (1 case), chemotherapy (1 case), chemotherapy + radiotherapy (2 cases). The time elapsed between the mastectomy and breast reconstruction was on average 2.5 years. There were 4 complications (66.7%) that required reintervention: early postoperative hematoma, infection and flap fat necrosis, abdominal suture dehiscence, fat necrosis + TRAM flap fibrosis. The evaluation of the results was subjective, obtaining very good results in 66.7% of the cases. There were no complications in the donor site. Discussion: The pedicled TRAM flap is the most used autologous tissue in breast reconstruction. Its complication rate is 26%, much lower than that obtained in our experience. The main complications are fibrosis and flap fat necrosis, flap loss, seroma and infection, with fat necrosis being the most frequent in our series. The use of TRAM flap gives greater satisfaction with appearance, size and sensation of the breast. Due to the results obtained, we believe that the pedicled TRAM flap is an excellent alternative for breast reconstruction in our hospital.

The clinical application of various forms of transverse rectus abdominis musculocutaneous flap in breast reconstruction and chest wall radiation ulcer repairment-Lessons learned and countermeasures

Objective To review outcome and experience in application of various forms of transverse rectus abdominis musculocutaneous flap in breast reconstruction and chest wall radiation ulcer repairment. Methods From January 2008 to February 2016, 61 cases (included 58 female patients and 3 male patients) were admitted, the age ranged from 39 to 57 years old. Among these cases, 37 cases received mastectomy and one-staged breast reconstructive operation and multiple chemotherapy preoperatively. The other 24 patients suffered from chest wall radiation ulcer, all occurred after mastectomy and radiotherapy, the course ranged from 12 to 56 months, all received long-time conservative therapy but the patient′s condition worsened. Of those patients 8 cases suffered radioactive bone injury , involved clavicle, rib and sterum; 3 cases suffered pleura injury; 2 cases suffered lung injury; 2 cases suffered brachial plexus injury and upper extremity lymphedema, resulted in upper extremity dysfunction. The patients were treated with pure pedicled transverse rectus abdominis musculocutaneous flap (TRAM) musculocutaneous flap in 31 cases, free TRAM musculocutaneous flap in 3 cases, pedicled TRAM musculocutaneous flap plus superficial inferior epigastric vein anastomosis in 13 cases, and pedicled TRAM musculocutaneous flap combined with contralateral free deep inferior epigastric perforator (DIEP) flap in 14 cases. Results The area of flap for chest wall reconstruction ranged from 22 cm×10 cm to 38 cm×15 cm, the size of flap for breast reconstruction ranged from 16 cm×10 cm to 22 cm×13 cm. The donor site was closed directly in all cases. Distal part necrosis and fat liquefaction were noted in 3 cases used pure pedicled TRAM musculocutaneous flap, in 1 case the defect was closed directly after radical debridement, in other 2 cases free anterolateral thigh flap was applied after debridement. All other 58 flaps survived uneventfully. All patients were followed up for 12-108 months with satisfied esthetic and functional results in reconstructed chest wall and breast. No local recurrence or ulcer happened. Only linear scar left in the donor sites, no hernia occurred. Conclusions Transverse rectus abdominis musculocutaneous flap is one of the first choice for breast reconstruction and chest wall radioactive ulcer.To ensure the operation success, it is efficient to apply different forms of transverse rectus abdominis musculocutaneous flap according to the flap size and blood supply. Key words: Surgical flaps; Rectus abdominis/SU; Epigastric arteries/SU; Mammaplasty; Skin ulcer/SU; Radiation injuries/SU; Thoracic injuries/SU

The Technique and Benefits of Angiographic Embolization of Inferior Epigastric Arteries Prior to Pedicled TRAM Flap Breast Reconstruction: Results from a Single Center.

To report a single center's experience with selective arterial embolization of the deep inferior epigastric arteries (DIEA) prior to pedicled TRAM flap breast reconstruction including techniques and outcomes. Retrospective chart review was performed for 15 patients who underwent pedicled TRAM flap breast reconstruction after selective embolization of bilateral DIEA. Data were analyzed to display the spectrum of postoperative outcomes following the TRAM flap procedure status post-selective angiographic embolization of the bilateral DIEA to improve vascularity of the TRAM flaps by rendering the tissue partially ischemic to undergo neovascularization. We then compared our results to historical controls of those delayed by ligating the DIEA via traditional surgical means to see if the outcomes are similar. We also compared our results to historical non-delayed TRAM flap reconstruction. One patient had a small area of partial flap skin necrosis, and no patients had total flap loss. 13.3% ofpatients had clinically significant TRAM flap fat necrosis. Outcomes of TRAM flaps delayed by selective arterial embolization are comparable to historical controls of those delayed by traditional surgical means and better than non-delayed flaps. Angiographic delayed TRAM flap reconstruction procedure is a reasonable safe alternative to the surgical delayed TRAM flap reconstruction procedure with less morbidity and is better than non-delayed TRAM flap procedures.

P295 - Variation in site of superior epigastric vessels. A guide to safe pedicled TRAM flap reconstruction

P295 - Variation in site of superior epigastric vessels. A guide to safe pedicled TRAM flap reconstruction

159P - Endoscopy-assisted breast surgery for breast cancer: updated results from study conducted by the Taiwan Endoscopic Breast Surgery Cooperative Group

Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or peri- areolar incisions is a possible alternative to open surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan. The medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2015 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan. A total of 345 EABS procedures were performed in 320 patients with breast cancer, including 25 (7.2%) patients with bilateral disease. The number of breast cancer patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012–2015. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.8%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.2%). Approximately 76% of the EATM procedures involved breast reconstruction, with the most common types of reconstruction being implant insertion and autologous pedicled TRAM flap surgery. During the seven-year study period, there was an increasing trend in the performance of EABS for the management of breast cancer when total mastectomy was indicated. The positive surgical margin rate was 1.4 %. Overall, the rate of complications associated with EABS was 13.2 % and all were minor and wound-related. During a median follow-up of 31.7 (4.2–75.6) months, there were 3 (1%) cases of local recurrence, 5 (1.4%) case of distant metastasis and 2 (0.5%) death. The updated results from the EABS program in Taiwan show that EABS is a safe procedure and results in acceptable cosmetic outcome. These findings could provide an alternative in surgical technique for certain breast cancer patients.

Current Trends in and Indications for Endoscopy-Assisted Breast Surgery for Breast Cancer: Results from a Six-Year Study Conducted by the Taiwan Endoscopic Breast Surgery Cooperative Group.

BackgroundEndoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to open surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan.MethodsThe medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan.ResultsA total of 315 EABS procedures were performed in 292 patients with breast cancer, including 23 (7.8%) patients with bilateral disease. The number of breast cancer patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012–2014. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.4%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.6%). Approximately 74% of the EATM procedures involved breast reconstruction, with the most common types of reconstruction being implant insertion and autologous pedicled TRAM flap surgery. During the six-year study period, there was an increasing trend in the performance of EABS for the management of breast cancer when total mastectomy was indicated. The positive surgical margin rate was 1.9%. Overall, the rate of complications associated with EABS was 15.2% and all were minor and wound-related. During a median follow-up of 26.8 (3.3–68.6) months, there were 3 (1%) cases of local recurrence, 1 (0.3%) case of distant metastasis and 1 (0.3%) death.ConclusionThe preliminary results from the EABS program in Taiwan show that EABS is a safe procedure and results in acceptable cosmetic outcome. These findings could help to promote this under-used surgical technique in the field of breast cancer.

Abstract P2-12-16: Current trend and indications of endoscopy-assisted breast surgery for breast cancer: Experience from Taiwan endoscopic breast surgery cooperative group

Abstract Background: Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to conventional surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan. Methods: The medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. The Taiwan Endoscopic Breast Surgery Cooperative Group (T-EBSCG) was established to monitor the effectiveness of and clinical outcome associated with EABS in Taiwan. The T-EBSCG comprises members from three major endoscopic breast surgery centers, namely Changhua Christian Hospital, National Cheng-Kung University Hospital,and Taipei Medical University Hospital in Taiwan. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan. Results: A total of 315 EABS procedures were performed in 292 patients with breast cancer, including 23 (7.8%) patients with bilateral disease. The mean tumor size of these 315 EABS was 2.2 ± 1.8 cm, and 44(13.9%) of them were multifocal/multicentric breast cancer. Lymph node metastasis was found during 23.3% of the procedures. The stage distribution of them were stage II cancer (n=103, 34.4%), followed by stage I cancer (n=92, 30.7%), ductal carcinoma in situ (stage 0) (n=86, 28.7%), and stage III breast cancer (n=19, 6.3%). The number of breast cancer patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012-2014. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.4%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.6%). Of the 269 patients who underwent EATM, 198 (73.6%) received immediate breast reconstruction. The majority (72.2%) of them received implant-based (cohesive Gel implant or tissue expander) reconstruction and the remaining 27.8% received autologous pedicled TRAM flap for breast reconstruction. Endoscopic assisted nipple sparing mastectomy with Gel implant reconstruction was the most frequently performed EABS now. During the six-year study period, there was an increasing trend toward more frequently use of EABS in the management of breast cancer when total mastectomy was indicated (EATM) than breast conserving surgery (EPM). Overall, the rate of complications associated with EABS was 15.2% and all were minor and wound-related. There were no major or life threatening complications. The positive surgical margin rate was 1.9%. During a median follow-up of 26.8 months (range, 3.3-68.6 months), there were 3 (1%) cases of local recurrence (1 ipsilateral breast recurrence, 1 axillary local recurrence, and 1 core needle biopsy tract recurrences), 1 (0.3%) case of distant metastasis, and 1 death. Conclusion: The EABS program in Taiwan showed that EABS is a safe procedure and results in acceptable cosmetic outcome, these findings could help to promote this under-used surgical technique in the field of breast cancer. Citation Format: Lai H-W, Kuo Y-L, Hung C-S, Chen S-T, Chen D-R. Current trend and indications of endoscopy-assisted breast surgery for breast cancer: Experience from Taiwan endoscopic breast surgery cooperative group. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-16.