Return of sensibility and final outcome of breast reconstructions using free transverse rectus abdominis musculocutaneous flaps

Abstract

Thirty-nine patients who had had free transverse rectus abdominis musculocutaneous (TRAM) flaps were studied and interviewed 5 months to 2.3 years after the procedure. The main reason why the patients had wanted the reconstruction in the first place was difficulty with the external prosthesis. Thirty three of 39 would have had the operation again; three were hesitant, and three had regrets for reasons other than that the breast was not satisfactory. All patients considered that the symmetry of the breasts was good or satisfactory with bras; without bras, one patient thought that the symmetry was poor, and the physician thought that the symmetry was poor in nine patients. Two-point discrimination turned out to be too delicate for studying the sensitivity of the breast. When pressure sensitivity was studied with von Frey monofilaments, the threshold values were significantly lower on the lateral and medial side and under the reconstructed breast than on the opposite side. In 22 patients the lateral part, and in 23 the medial part, of the reconstructed breast was insensate. There was good or satisfactory pressure sensitivity on the lateral side in nine patients and on the medial side in eight. The return of sensitivity to the autogenous breast reconstruction was variable among the patients studied, but it did not affect their satisfaction with the reconstruction.