Evaluation of Abdominal Sensibility after TRAM Flap Breast Reconstruction
Scott L. Spear, M.D.; Christopher L. Hess, M.D.; Mohamed W. Elmaraghy, M.D., F.R.C.S.(C)
From the Division of Plastic Surgery, Georgetown University Medical Center.
PLASTIC AND RECONSTRUCTIVE SURGERY 2000;106:1300-1304
One commonly expressed concern regarding transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction surgery is the return of sensation to the abdomen. Although many studies have focused on abdominal wall muscle incompetence or herniation, there is limited literature discussing postoperative abdominal sensation. The purpose of this study was to assess abdominal sensation a minimum of 1 year after pedicled TRAM flap surgery for breast reconstruction.
Twenty-five female patients who underwent TRAM flap breast reconstruction a minimum of 1 year before the study were compared with 10 female volunteer controls. Subject and control abdomens were specifically divided into 12 zones, then assessed for superficial touch, superficial pain, temperature, and vibration using various techniques. Fischerís exact test was used for analysis with the p value set at p = 0.05. The degree to which superficial touch was affected was then tested using Semmes-Weinstein monofilaments. Studentís t test was used for analysis with the p value set at p = 0.05.
For all four sensory modalities, subjects were found to have decreased sensation in zones 5 and 8, the supraumbilical and infraumbilical regions. This was statistically significant. When assessed with Semmes-Weinstein monofilaments, the sensation of the subjectsí abdomens was significantly decreased compared with controls. Significance was found in all zones.
This study clearly demonstrates that there is a significant and persistent reduction in abdominal sensibility following TRAM flap surgery. The distribution of the deficits is consistent and involves the midline supraumbilical and infraumbilical regions.
The TRAM flap has become the procedure of choice for postmastectomy autogenous breast reconstruction. It provides the plastic surgeon with a relatively safe, reliable, and aesthetically pleasing method of breast reconstruction. Since its inception, the TRAM flap and its abdominal closure have undergone numerous modifications designed to minimize donor-site morbidity and create a natural-looking breast. In addition to creating an aesthetically pleasing breast, the TRAM flap has the potential advantage of postoperative improvement in abdominal contour.
Plast Reconstr Surg 2000 November;106(6):1300-1304
Published by Lippincott Williams & Wilkins
Judy talks about her
Tram flap in 1997
NP Tells her Tale
Patient Perspective-Susan W.
(Male) Partner experiences of breast reconstruction post mastectomy
Diana sent us this comment
American Association of Plastic Surgeons,
89th Annual Meeting Abstracts, April 2010
Archives of Internal Medicine, March 2001
Needs larger studies to determine relationship
Surgical Instrument Damage to Breast Implants
Silicone Implants-Correlations w/Illness
One Study Finds NO Link to Specific Ailments
Plastic & Reconstructive Surgery
Late Results: Tram Flap Reconstruction II
Comparison Of Immediate & Delayed Free TRAM Flap
Simultaneous Bilateral Breast Reconstruction/Latissimus Dorsi
Contour Abnormalities of Abdomen After Transverse
Endoscope-Assisted Subcutaneous Mastectomy & Reconstruction
Unipedicled & Bipediculed TRAM Flap
Several options now available
Doctors' Guide Review
J Plastic & Reconstructive Surgery,
Nipple-Sparing Mastectomy-NO GOOD
Boost of Well-Being
Chest Wall Recurrence After Reconstruction
Cancer Control, 2001
Timing of Reconstruction
Radiation Therapy & Breast Reconstruction
Treatment of the Contralateral Breast (other side)
Patient Benefits of Breast Reconstruction
Conclusions and References
Pre-operative Abdominal Exercises
NO Need for Autologous Blood Transfusion withTram Flap
Br J Plastic Surgery, 12/01
Plast Reconstr Surg, 8/00
Post-mastectomy Rtx & Transverse Flap
Postmastectomy RTx After TRAM
British J of Plastic Surgery, 1997
Implications for Abdominal Wall Function/Strength
The Breast, 7/02
Plastic & Reconstructive Surgery, 7/02
Lost journal reference,
and doctor's response
Very sorry we lost the Journal
Breast Prosthetics from Medscape Women's Health
Resources for Breast Prosetheses
Sclerderma & Silicone Gel Prostheses
Annals of Plastic Surgery, 5/04
Press Release, 10/06
Am Soc of Plastic Surgeons
LINK: Site about those who are not reconstructed.
Includes photos and discussions
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