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Impact of Prior Ipsilateral Chest Wall Radiation on Pedicled TRAM Flap Breast Reconstruction

Chun, Yoon S. MD*; Verma, Kapil MD; Sinha, Indranil MD*‡; Rosen, Heather MD, MPH§; Hergrueter, Charles MD*; Wong, Julia MD; Pribaz, Julian J. MD*

doi: 10.1097/SAP.0b013e318248b643
Breast Surgery

Background This study compares complication rates between transverse rectus abdominis myocutaneous (TRAM) flaps based on previously irradiated versus nonirradiated superior pedicles to assess the impact of prior ipsilateral chest wall radiation on pedicled TRAM flap breast reconstruction.

Methods A retrospective study of 302 consecutive TRAM flap reconstructions was performed; 76 TRAM flaps based on a previously irradiated superior epigastric pedicle were compared to 226 TRAM flaps based on a nonirradiated pedicle in medical comorbidities, oncologic data, and complications.

Results Patients having undergone previous chest wall irradiation had a higher cancer stage, but demographic data were otherwise similar within the groups. Previous chest wall irradiation did not result in increased rate of flap loss, infection, and fat necrosis. However, there was a trend toward higher revision rate in the previously irradiated TRAM group.

Conclusions Previous radiation to the superior epigastric pedicle is not associated with a significant increase in flap complications and should be considered a viable modality for pedicled TRAM flap breast reconstruction.

From the *Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School; †Harvard Medical School; ‡Harvard Plastic Surgery Residency Program, Harvard Medical School, Boston, MA; §Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital; and ∥Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA.

Received October 25, 2011, and accepted for publication, after revision, December 28, 2011.

Dr Chun and Dr Verma contributed to this project equally.

Presented at the American Association of Plastic Surgeons 90th Annual Meeting, in Boca Raton, FL, April 9–12, 2011, and at the Plastic Surgery Research Council 56th Annual Meeting, in Louisville, KY, April 28–30, 2011.

Conflicts of interest and sources of funding: none declared.

Reprints: Yoon S. Chun, MD, Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital/Faulkner Hospital, 1153 Centre St, Suite 21, Boston, MA 02130. E-mail:

© 2013 by Lippincott Williams & Wilkins