Transverse Rectus Abdominis Myocutaneous Breast Research Articles

The "Nipple-Licus": the Everted Umbilicus for Immediate Nipple Reconstruction in Mid-Abdominal Transverse Rectus Abdominis Myocutaneous Breast Reconstruction

The "Nipple-Licus": the Everted Umbilicus for Immediate Nipple Reconstruction in Mid-Abdominal Transverse Rectus Abdominis Myocutaneous Breast Reconstruction

Latissimus dorsi flap versus pedicled transverse rectus abdominis myocutaneous breast reconstruction: outcomes

BackgroundPedicled breast reconstruction is a mainstay treatment for plastic surgeons. Although indications vary for each breast reconstruction technique, there exist some overlapping characteristics that may determine a successful outcome. We aimed to determine the impact flap selection has on postoperative outcomes and resource utilization. Materials and methodsNationwide Inpatient Sample database (2010–2011) was reviewed for cases of latissimus dorsi (LD; International Classification of Diseases, Ninth Revision, Clinical Modification, 85.71) and pedicled transverse rectus abdominis myocutaneous (pTRAM; 85.72) breast reconstruction. Males were excluded. Demographic, socioeconomic, clinical factors, postoperative complications, length of stay (LOS), and total charges (TC) were assessed. Chi-squared and multivariate analyses were performed to identify independent risk factors of resource utilization and postoperative complications. ResultsA total of 29,074 cases were identified; 17,670 (61%) LD and 11,405 (39%) pTRAM. 74% percent were Caucasian, 94% insured, and 66% were treated in teaching hospitals. There were 24 mortalities (15 LD, 9 pTRAM). LD patients were more likely to be obese (odds ratio [OR] = 1.3), suffer from flap loss (OR = 1.4), wound infection (OR = 1.6), wound dehiscence (OR = 2.2), and hematoma (OR = 1.3), P < 0.05. Patients undergoing pTRAM were more likely to undergo surgical revision (OR = 6.9), suffer from systemic infection (OR = 1.8), pneumonia (OR = 5.0), or pulmonary embolism (OR = 29.2), P < 0.05. Risk-adjusted multivariate analysis demonstrated LD was an independent risk factor for postoperative complication (OR = 1.4) and increased TC (OR = 1.3), P < 0.001. Conversely, undergoing pTRAM was an independent risk factor for increased LOS (OR = 6.3), P < 0.001. ConclusionsAnalysis of a national database found LD breast reconstruction to have higher TC and increased risk for surgical site complications. Patients undergoing pTRAM had increased risk for pulmonary complications and LOS. Procedure selection may be refined as additional characteristics are discovered using outcomes-based research.

The drain game: Abdominal drains for transverse rectus abdominis myocutaneous breast reconstruction

We recently published data for the duration of donor site drain use in latissimus dorsi and deep inferior epigastric perforator breast reconstruction, due to a reported requirement in the literature; evidence is still required for transverse rectus abdominis myocutaneous (TRAM) reconstruction. To compare inpatient hospital stay, drainage parameters and donor-site complications associated with closed suction abdominal drain removal by post-operative day (POD) 3 regardless of output (early group), versus after POD 3 where instructions were by drainage volume/24h±output consistency (late group), in post-mastectomy TRAM breast reconstruction. A retrospective review of TRAM breast reconstructions, between June 2008-2013, was undertaken with a minimum 1 year follow-up per patient. Of 65 patients who underwent TRAM breast reconstruction, 56 hospital records contained complete documentation. Both the late (n=35) and early (n=21) drain removal group were matched for age and number of donor site drains (2perpatient). Mean drain removal day (5.34±0.20days vs. 2.67±0.14days; p<0.0001), total drainage (797.86±77.15 mls vs. 295.71±29.72 mls; p<0.0001) and hospital inpatient stay (7.46±0.29days vs. 6.09±0.32days; p=0.003) were greater for patients in the late versus early group. There were no differences in total complications (5.71%(2/35) vs. 14.29%(3/21); p=0.28), including seroma (2.86%(1/35) vs. 4.76%(1/21); p=0.71) rates between the late and early groups. These data suggest significant advantages for patients who have abdominal drains removed early by POD 3, without increased post-operative complications including seroma rates; these data are in keeping with our LD data. We recommend drain removal by POD 3.

Safety of Immediate Transverse Rectus Abdominis Myocutaneous Breast Reconstruction for Patients With Locally Advanced Disease

Safety of Immediate Transverse Rectus Abdominis Myocutaneous Breast Reconstruction for Patients With Locally Advanced Disease

4–37 Safety of Immediate Transverse Rectus Abdominis Myocutaneous Breast Reconstruction for Patients With Locally Advanced Disease

4–37 Safety of Immediate Transverse Rectus Abdominis Myocutaneous Breast Reconstruction for Patients With Locally Advanced Disease

Safety of Immediate Transverse Rectus Abdominis Myocutaneous Breast Reconstruction for Patients With Locally Advanced Disease

Immediate transverse rectus abdominis myocutaneous breast reconstruction combined with postoperative radiation therapy after mastectomy is safe and effective. Retrospective case series. University-based teaching hospital. From January 1, 1996, through December 31, 2003, 252 patients underwent mastectomy and immediate transverse rectus abdominis myocutaneous flap reconstruction. Of those, 35 patients received postoperative radiation therapy (stage I, n = 1; II, n = 17; III, n = 15; IV, n = 2). Age range was 29 to 72 years (mean, 49.5 years). Follow-up was 1 to 8 years (mean, 48 months). Flap loss, fat necrosis, flap volume loss, adjuvant treatment delay, and need for additional surgery. The rate of flap survival was 100%. Median operative time was 5.5 hours. Average hospital stay was 5.2 days. Fat necrosis occurred in 3 patients, with volume loss requiring additional surgery in 2 patients (6%). Postoperative adjuvant therapy was not significantly delayed (median interval, 32 days). With a median follow-up of 48 months, local recurrence was present in only 1 patient (3%), who underwent successful local salvage, and distant metastasis occurred in 4 patients (11%). Immediate transverse rectus abdominis myocutaneous breast reconstruction followed by radiation therapy is safe, with minimal morbidity and no significant change in tissue volume. Complications tend to be minor, not delaying adjuvant therapy. Immediate breast reconstruction should be considered after mastectomy, despite the need for postoperative radiation therapy.