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. 2004 May;18(2):79-87.
doi: 10.1055/s-2004-829042.

Trends in autologous breast reconstruction

Grant W Carlson  1
Affiliations

Trends in autologous breast reconstruction

Grant W Carlson. Semin Plast Surg. 2004 May.

Abstract

Several trends have influenced autologous breast reconstruction in the last decade. The development of the skin-sparing mastectomy has markedly improved the aesthetic results of autologous breast reconstruction. Modifications have included purse-stringing periareolar incisions and vertical reduction pattern incisions. The increasing use of postmastectomy has had a negative impact on transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction. Delayed reconstruction may be the best option when adjuvant radiation is planned. Careful anatomic studies of the blood supply to the abdominal wall and critical outcome analyses have resulted in many refinements in TRAM flap breast reconstruction. Careful patient selection is critical to avoid complications. Obesity, tobacco smoking, a history of chest wall radiation, and abdominal scars are known risk factors for wound complications. TRAM flap reconstruction should be considered a two-stage procedure regardless of nipple reconstruction. The first stage is building the foundation and framework of the breast. The second stage is essential for final adjustments to the volume, contour, and position of the breast mound.

Keywords: Skin sparing mastectomy; TRAM flap; radiation.

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Figures

Figure 1
Figure 1
(A) Preoperative view of a 42-year-old patient after a left breast biopsy revealed ductal carcinoma in situ (DCIS). (B) Postoperative view after a SSM type II and a unipedicle TRAM flap reconstruction.
Figure 2
Figure 2
Types of skin-sparing mastectomy.
Figure 3
Figure 3
(A) Preoperative view of a 34-year-old patient with a strong family history of breast cancer. (B) Postoperative view after modified SSMs type IV and TRAM flap reconstruction. The SSMS were performed via a vertical incision and purse-stringing of the areola excision.
Figure 4
Figure 4
(A) Patient who underwent a unipedicle TRAM flap reconstruction. She is 6 weeks postradiation therapy. Skin excoriation is noted. (B) Three months postradiation. The flap has become fibrotic and there is a large area of fat necrosis in the superior pole.
Figure 5
Figure 5
(A) Postoperative view of a patient after a unipedicle TRAM flap reconstruction. She underwent an SSM using a vertical reduction pattern skin incision. (B) Postoperative view after placement of an implant under her TRAM flap as well as a augmentation mastopexy on the contralateral side.
Figure 6
Figure 6
(A) Postoperative view after ipsilateral unipedicle TRAM flap reconstruction TRAM flap. The inframammary fold has lost definition. (B) Postoperative view after revision of the IMF via an external inframammary incision.
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