ABSTRACT: The Coincidence of TRAM Flaps and Prostheses in the
Setting of Breast Reconstruction
It is well known that transverse rectus abdominis myocutaneous
(TRAM) flaps can be used to replace unsatisfactory prosthetic
breast reconstructions; however, little has been written about the
scope of breast implant use in TRAM flap patients.
In this study,
to ascertain the range of such therapeutic options, their frequency,
and their clinical outcomes, the authors retrospectively reviewed
the senior author's breast reconstruction experience from 1989 to
2000 with patients in whom both a TRAM flap and an implant were
used for breast reconstruction.
The authors examined the surgical
indications, body habitus, bra size, chest wall irradiation history,
flap type, implant type, complications, and outcomes for those
patients with TRAM flap and breast implant combinations.
Thirty-two women who had 50 (various) combinations of a TRAM flap
and a breast implant were identified. There were more clinical
scenarios than patients because many of the women had multiple
The 50 combination scenarios were then divided into six
groups. Group I consisted of 14 patients who had elective prostheses
placed beneath simultaneous TRAM flaps; group II consisted of 10
patients who had TRAM flaps with contralateral prosthetic reconstruction
(in which two implants were received before the TRAM flaps, five
implants were received simultaneously with the TRAM flaps, and three
implants were received after the TRAM flaps); group III consisted of
eight patients who had contralateral augmentation in addition to
their TRAM flaps; group IV consisted of 11 patients who had TRAM
flaps that were used to cover or replace previous prosthetic
reconstructions; group V consisted of four patients in whom
prostheses were used to augment or improve previous TRAM flap
reconstructions; and group VI consisted of three patients who
required prostheses to either reconstruct or salvage total or
near-total TRAM flap failures.
A broad range of implant types was
used, although anatomic saline implants predominated. Forty-one
percent of the patients in the review had undergone irradiation
during the course of their treatment for breast cancer.
the 32 patients experienced a total of twelve complications, four
of which were related to the implants and eight of which involved
the TRAM flaps and abdominal donor sites.
Although complex, the wide variety of potential TRAM flap/breast
implant combinations can be useful for patients with challenging
reconstructive scenarios, particularly those that involve radiation
In the group of patients reviewed by the authors, TRAM flaps
were most often used in successful partnership either on the same side
as or opposite to an implant reconstruction. A TRAM flap was used to
salvage or replace an unsatisfactory implant reconstruction in less
than a third of the patients.
From a risk point of view, implants used
opposite a TRAM flap reconstruction had a lower incidence of
complication than did implants used beneath TRAM flaps.
[08/01/2002; Plastic and Reconstructive Surgery]
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