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500 Consecutive Patients with Free TRAM Flap Breast Reconstruction: A Single Surgeon’s Experience

Vega, Stephen M.D.; Smartt, James M. Jr M.D.; Jiang, Shao M.D.; Selber, Jesse C. M.D., M.P.H.; Brooks, Christopher J. M. M.D.; Herrera, H Raul M.D.; Serletti, Joseph M. M.D.

Plastic and Reconstructive Surgery: August 2008 - Volume 122 - Issue 2 - p 329-339
doi: 10.1097/PRS.0b013e31817f45cb
Breast: Original Articles

Background: This study reports on the longitudinal experience and outcomes of one surgeon performing free transverse rectus abdominis musculocutaneous (TRAM) flaps on 500 consecutive patients between 1992 and 2003.

Methods: A retrospective review of hospital and outpatient records was performed. Specific risk factors for successful reconstruction were reviewed, including American Society of Anesthesiologists class, obesity, smoking, medical comorbidities, and irradiation and chemotherapy history. Outcomes measured included the length of hospital stay and the incidence of complications including both thrombotic and nonthrombotic complications.

Results: Five hundred sixty-nine free TRAM breast reconstructions were performed in a total of 500 patients. Preoperative patient risk factors included obesity, smoking, hypertension, diabetes, and cardiac disease, with three-fourths of the patients being American Society of Anesthesiologists class II or III. Intraoperative or postoperative thrombosis occurred in 35 reconstructions (6.2 percent). Only one patient had a total flap loss, for a flap success rate of 99.7 percent. Significant nonthrombotic complications occurred in 67 patients (13.4 percent). The most common nonthrombotic complications included wound infection (3 percent), fat necrosis (3 percent), and delayed healing (3 percent). Revision procedures after free TRAM reconstruction were performed in 14.4 percent of cases.

Conclusions: The free TRAM flap is a highly reliable method of autogenous breast reconstruction in a broad spectrum of patients. This free flap has a very low thrombotic complication rate, and abdominal donor defect problems have been limited. Finally, this method of reconstruction can be reliably offered to a wide group of patients, including those considered at high risk for a pedicled TRAM flap reconstruction.

Philadelphia, Pa.; and Rochester, N.Y.

From the Division of Plastic Surgery, University of Pennsylvania School of Medicine, and the Division of Plastic Surgery, University of Rochester School of Medicine and Dentistry.

Received for publication April 9, 2007; accepted January 30, 2008.

Presented at the Annual Meeting of the American Association of Plastic Surgeons, in Chicago, Illinois, May 2004.

Disclosure: None of the authors has any financial conflicts of interest in the publication of this article.

Joseph M. Serletti, M.D., Division of Plastic Surgery, University of Pennsylvania, 10 Penn Tower, 3400 Spruce Street, Philadelphia, Pa. 19104,

©2008American Society of Plastic Surgeons