TRAM flap in reconstructive operations in patients with breast cancer

The treatment of breast cancer (BC) is a relevant problem. Surgery is a key treatment method for BC. The volume of its operations varies from radical mastectomies to lumpectomies and, in the areas of regional metastases, from three-level lymphadenectomy to sentinel lymph node biopsy. Objective: to assess whether a displaced TRAM flap may be used for reconstructive operations for BC. The paper presents some experience in treating 11 BC patients in whom a displaced TRAMP flap was employed for reconstruction. At this time, the displaced TRAM flap was applied for delayed reconstruction in 3 patients. The mean age of the patients was 45.5 ± 15.7 years. In 8 BC patients undergoing one-stage reconstruction with a displaced TRAM flap, the treatment schedule was as follows: surgical treatment in 1 patient, combined treatment in 2 patients, and multimodality treatment in 5. The patients received targeted therapy in 3 cases or hormone therapy in 6. A lower abdominal skin-and-fat flap on one vascular pedicle was used in all the 11 patients.
Indications for using a displaced TRAM flap were determined; complications were analyzed. The percentage of complications due to the use of a displaced TRAM flap was 9.1 % in our study.
To reduce the rate of complications after breast reconstruction with a displaced TRAM flap, we carefully selected patients for this choice
of a plastic component. The displaced TRAM flap is one of the variants for delayed breast reconstruction despite its duration and complexity. Corrective surgery is further used to achieve breast symmetry. Corrective operations, namely, breast liposuction and submammary fold formation, were performed in 2 patients. For full breast recovery, the nipple-areolar complex is to be formed following skin-sparing mastectomies and delayed breast reconstructions. The cosmetic effect was evaluated in 11 patients as excellent in 4 (36.4 %) cases, good in 7 (63.6 %). Neither local recurrences nor distant metastases were revealed in the 11 patients during one-year follow-up.

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