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The Pedicled TRAM Flap in Breast Reconstruction

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Breast Cancer

Abstract

Breast reconstruction using autologous techniques [1] have undergone considerable change in recent years. Earlier implant and expander-implant reconstructions achieved mound creation, but a natural ptotic breast shape remained an elusive goal. Recent advances in implant shape and texture technology coupled with the use of acellular dermal matrices have done much to dramatically improve implant-based outcomes in reconstruction, constituting over 80% of all breast reconstructions performed in the United States at this time. Some surgeons find the attendant complication rates and need for long-term maintenance troubling. Distortion and capsular contracture did little to encourage reconstructive surgeons and may well have contributed significantly to Veronesi’s successful focus on breast conservation therapy. While capsular contracture is no longer the major problem it used to be, implant-based reconstruction definitely requires ongoing maintenance in the long term. The advent of autologous techniques with the latissimus dorsi and then transverse rectus abdominis myocutaneous (TRAM) flap and its derivatives for breast reconstruction revolutionized breast reconstruction, enabling surgeons to create a breast that is soft, warm, and well integrated into a patient’s psyche. The latissimus flap often requires an additional implant, but TRAM flap techniques enabled us to create a truly autologous breast reconstruction without the need for long-term maintenance or adverse events. The popularity of skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) has made further landmark advances in breast reconstruction, attaining the goal of a natural, almost scarless reconstructed breast. These oncologically safe procedures do not compromise mastectomy outcomes [2–4]. Combined with TRAM flap reconstruction whether pedicled or free, the technique offers potential for increasing patient acceptance of mastectomy as an alternative to breast conservation therapy (BCT). In our practice, 95% of patients undergoing mastectomy select immediate reconstruction with skin- or nipple-sparing mastectomy, while a minority present for delayed reconstruction.

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Acknowledgment

The author wishes to acknowledge the contribution of Bill Winn, a medical illustrator, without whose help this manuscript would not have been possible.

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Authors and Affiliations

  1. Illinois Plastic Surgery, Professor of Surgery (Plastic and Reconstr), University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA

    Glyn Jones M.D., FRCS(Ed), FCS(SA), FACS

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  1. Glyn Jones M.D., FRCS(Ed), FCS(SA), FACS
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Correspondence to Glyn Jones M.D., FRCS(Ed), FCS(SA), FACS .

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Editors and Affiliations

  1. European Institutee of Oncology, Milan, Italy

    Umberto Veronesi

  2. European Institute of Oncology, Milan, Italy

    Aron Goldhirsch

  3. European Institute of Oncology, Milan, Italy

    Paolo Veronesi

  4. San Raffaele University and Research Hospital, Milano, Italy

    Oreste Davide Gentilini

  5. European Institute of Oncology, Milan, Italy

    Maria Cristina Leonardi

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Jones, G. (2017). The Pedicled TRAM Flap in Breast Reconstruction. In: Veronesi, U., Goldhirsch, A., Veronesi, P., Gentilini, O., Leonardi, M. (eds) Breast Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-48848-6_36

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