Assessment of breast volume change after transverse rectus abdominis myocutaneous flap

Abstract

Background: The evaluation of a breast after breast reconstruction depends on a surgeon's subjective criteria. We used computed tomography (CT) scans to obtain an objective evaluation of the postoperative results by measuring the breast volume of patients who had undergone breast reconstruction using pedicled transverse rectus abdominis myocutaneous (TRAM) flaps. This research will help in the objective postoperative evaluation of reconstructed breasts, and also in the preoperative flap size designs.

Methods: A total of 27 patients underwent breast reconstruction using pedicled TRAM flaps after mastectomy from September 2007 to July 2010. Of these, 10 patients who were followed up and underwent CT scans 2 or more times during the follow-up period were included in this study. We evaluated the change in breast volume over time using CT scans, and the interval breast volume change between CT scans.

Results: All of the 10 patients' reconstructed breasts showed a volume decrease over time. The breast volume changes in the intervals between CT scans were as follows: 5.65% decrease between the first CT and second CT scan, 2.3% decrease between the second CT and third CT scan, (statistically significant) and 1.89% decrease between the third CT and forth CT scan. (not statistically significant).

Conclusions: This research shows the possibility of objectively evaluating the postoperative breast volume changes. The findings will be helpful in designing the size of TRAM flaps to use on defects after mastectomy. Based on these results, we should also closely observe the reconstructed breast volume for at least 2 years.

Keywords: Mammaplasty; Multidetector computed tomography; Organ size.

Fig. 1

Author's method for measuring the breast volume (A) The boundary of the breast is selected in each axial view section of computed tomography. (B) The anterior view of a 3-dimensional (3D) reconstructed image. (C) The basal view of a 3D reconstructed image. (D) The breast volume is measured.

Fig. 2

This figure shows what we evaluated and what is VC We defined "volume change (VC)" as interval volume change between computed tomography (CT) scans. In this study, VC was breast volume change proportional to breast volume in the former CT scan. TRAM, transverse rectus abdominis myocutaneous.

Fig. 3

Volume change of the reconstructed breast using TRAM flap in patient 7 (A) Measurement value of the breast on the first CT. (B) Measurement value of the breast in the fourth CT, 3 years and 4 months later. This figure shows the volumetric decrease of the breast over time. TRAM, transverse rectus abdominis myocutaneous; CT, computed tomography.

Fig. 4

This figure shows that breast volume changed in the interval between CT scans The first (5.65%) and second (2.3%) breast volume changes are statistically significant. However, the third breast volume change (1.89%) is not statistically significant. These results mean that the reconstructed breast volume change after 3 years can be ignored; therefore, the volume of a reconstructed breast should be closely observed for at least 2 years. TRAM, transverse rectus abdominis myocutaneous; CT, computed tomography.