Annals of Surgical Oncology

, Volume 5, Issue 5, pp 456–463

Is mammography useful in screening for local recurrences in patients with TRAM flap breast reconstruction after mastectomy for multifocal DCIS?


  • A. P. Salas
    • From the Division of Surgical OncologyUniversity of Michigan Medical Center
  • Mark A. Helvie
    • Department of SurgeryUniversity of Michigan Medical Center
    • the Department of RadiologyUniversity of Michigan Medical Center
  • Edwin G. Wilkins
    • the Plastic Surgery SectionUniversity of Michigan Medical Center
  • Harold A. Oberman
    • the Department of PathologyUniversity of Michigan Medical Center
  • Peter W. Possert
    • the Department of Radiation OncologyUniversity of Michigan Medical Center
  • Alan M. Yahanda
    • From the Division of Surgical OncologyUniversity of Michigan Medical Center
  • Alfred E. Chang
    • From the Division of Surgical OncologyUniversity of Michigan Medical Center
Original Articles

DOI: 10.1007/BF02303866

Cite this article as:
Salas, A.P., Helvie, M.A., Wilkins, E.G. et al. Annals of Surgical Oncology (1998) 5: 456. doi:10.1007/BF02303866


Background: Skin-sparing mastectomy with immediate transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction is being used more often for the treatment of breast cancer. Mammography is not used routinely to evaluate TRAM flaps in women who have undergone mastectomy. We have identified the potential value of its use in selected patients.

Methods and Results: We report on four women who manifested local recurrences in TRAM flaps after initial treatment for ductal carcinoma in situ (DCIS) or DCIS with microinvasion undergoing skin-sparing mastectomy and immediate reconstruction. All four patients presented with extensive, high-grade, multifocal DCIS that precluded breast conservation. Three of four mastectomy specimens demonstrated tumor close to the surgical margin. Three of the four recurrences were detected by physical examination; the remaining local recurrence was documented by screening mammography. The recurrences had features suggestive of malignancy on mammography.

Conclusion: We conclude that all patients undergoing mastectomy and TRAM reconstruction for extensive, multifocal DCIS should undergo regular routine mammography of the reconstructed breast. Our experience with this subgroup of patients raises concern about the value of skin-sparing mastectomy with immediate reconstruction for therapy. Adjuvant radiation therapy should be recommended for those patients with negative but close surgical margins.

Key Words

MammographyBreast cancerLocal recurrenceDuctal carcinoma in situSkin-sparing mastectomy

Copyright information

© The Society of Surgical Oncology, Inc. 1998