Delayed TRAM in Breast Reconstruction

Ismail, Karima; Ismail, Mariam; Ismail, Ahmed

doi:10.21608/ejprs.2020.113507

Delayed TRAM in Breast Reconstruction

Document Type : Original Article

Authors

The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Cairo University

10.21608/ejprs.2020.113507

Abstract

Introduction: Breast reconstruction following modified
radical mastectomy has evolved into either autogenous or
implant depending reconstruction. In autogenous breast reconstruction
TRAM (transverse rectus abdominal myocutaneous)
flap was previously considered the best modality.
However, an incidence of 30-40% complication rate was
linked to this flap. Accordingly, many surgeons shifted to use
flaps depending on microsurgery in breast reconstruction;
among these flaps is DIEP flap which is most commonly used.
The aim of this study is to prove that delay of TRAM flap is
an efficient method to decrease complication rate of such flap < br />to a minimum.
Material and Methods: This is a retrospective study since
2010 till 2016, it involved 24 cases suffering from breast
cancer and managed by modified radical mastectomy. All
cases did delay breast reconstruction by delayed TRAM flap.
The age varied from 40 years old to 65 years old with an
average of 52.5 years old. All cases were obese BMI >30, 13
cases (54.1%) were diabetic, 10 cases (41.6%) had previous
caesarean section, 2 cases (8.3%) had vertical abdominal wall
scar. All patients went through a first stage of delay; after 2
to 3 weeks separation and inset of the flap was done.
Results: Follow-up was done for a minimum of 1 month.
All flaps survived completely with no major complication.
Early complications varied from 3 cases (12.5%) had seroma,
2 cases (8.3%) had dehiscence at the lateral border from
mastectomy flap, 2 cases (8.3%) had hardening, redness and
hotness. Late complications, 2 cases (8.3%) had abdominal
wall weakness.
Conclusion: Tips in the delay and harvest of the flap were
emphasized by lower number of complications in this group < br />of high-risk patients. Delayed TRAM is a safe reliable procedure
that ensures long term desired aesthetic outcome & less
complication rate than DIEP free flap and TRAM.

Keywords

Main Subjects

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