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Immediate Transverse Rectus Abdominis Musculocutaneous Flap Reconstruction Is Associated With Improved Cancer-Specific Survival in Locally Advanced Breast Cancer

Hsieh, Tung-Ying MD*; Lin, Yun-Nan MD*; Lin, Sin-Daw MD*; Lai, Chung-Sheng MD, PhD*; Chang, Kao-Ping MD, PhD*; Lee, Su-Shin MD*; Huang, Shu-Hung MD*; Hou, Ming-Feng MD; Chen, Fang-Ming MD; Ou-Yang, Fu MD

doi: 10.1097/SAP.0000000000000251
Clinical Articles

Background This study of stage III (locally advanced) breast cancer patients evaluated the survival improvement conferred by immediate breast reconstruction by transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction after modified radical mastectomy (MRM) in comparison with MRM alone.

Methods This retrospective study analyzed data for all women who had received TRAM immediately after unilateral modified radical mastectomy for locally advanced breast cancer at a single institution from January 2002 to December 2009. The analysis included 192 patients divided into 2 groups: patients who had received MRM immediately followed by TRAM flap reconstruction (MRM-TRAM group, n = 52) and patients who had received MRM alone (MRM group, n = 140). Data collection included demographic characteristics, underlying comorbidities, and cancer characteristics. Postoperative adjuvant therapies, oncologic outcomes, and survival were compared between the 2 groups. Kaplan-Meier plots, univariate log-rank test, multivariate Cox proportional hazards regression models, and t-test were used to evaluate potential predictors of cancer recurrence and patient survival.

Results In comparison with the MRM group, significant differences in the MRM-TRAM group included a younger mean age, a better overall health status, and a higher education level (all P < 0.001). Severity of breast cancer disease did not significantly differ in terms of cancer characteristics. Additionally, there were no significant differences in local recurrence (P = 0.326) and distant metastasis (P = 0.338). Immediate breast reconstruction was not associated with delays in detection of local recurrence and initiation of adjuvant therapies

The 5-year breast cancer-specific survival rate was significantly higher in the MRM-TRAM group (84.6%) compared with the MRM group (61.2%) (P = 0.003). Multivariate analysis showed that TRAM flap reconstruction is an independent predictor of survival in breast cancer patients. The MRM-TRAM group had a significantly lower hazard of death (HR, 0.235; 95% CI, 0.070–0.788; P = 0.019) compared with the MRM group.

Conclusions Immediate TRAM flap reconstruction is oncologically safe and is unassociated with delayed adjuvant therapies or delayed detection of local recurrence. Patients with locally advanced breast cancer can be considered appropriate candidates for TRAM flap reconstruction because the procedure is an independent predictor of breast cancer survival and is associated with a 76.5% decrease (HR, 0.235) in the risk of cancer death.

From the *Division of Plastic and Reconstructive Surgery, and †General Surgery Medicine, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China.

Received March 27, 2014, and accepted for publication, after revision, April 2, 2014.

Conflicts of interest and sources of funding: none declared.

Reprints: Sin-Daw Lin, MD, Division of Plastic and Reconstructive Surgery, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan. E-mail:

© 2014 by Lippincott Williams & Wilkins