Background: Breast cancer is the most common cancer in Thai women. Current treatments of breast cancer aim not only at
complete cure but also at maintaining the patients’ quality of life. Mastectomy is still a standard procedure for removal of
cancer, but nowadays the patient has many modalities to choose from in order to achieve cosmetic satisfaction. Breast
reconstruction with transverse rectus abdominis myocutaneous (TRAM) flap is one of the options; however, it is a complicated
procedure because of its resultant longer operative time, decrease in abdominal wall strength, and unpredict ability of blood supply in some areas.
Objective: The aim of this study was to report the complications and outcomes of breast reconstruction with TRAM flap performed by a single surgeon in Rajavithi Hospital.
Material and Method: An observational retrospective study review was performed of all women who underwent breast
reconstruction with TRAM flap after mastectomy between June 2012 and June 2013. A total of 20 patients were recruited of
which one had ductal carcinoma in situ (DCIS), 7 had stage I cancers, 7 had stage II, 4 had stage III, and 1 had large
phyllodes tumor. Details of operative time, immediate postoperative complications, length of hospital stay and time to return to work were recorded. The patients were asked to grade their satisfaction with the reconstruction procedure on a 5-point
scale (5 points: extremely satisfied; 1 point: extremely dissatisfied) 3 months after surgery.
Results: The mean operative time was 4 hours and 45 minutes. Average follow-up time was 2 years. Postoperative complications occurred in 5 patients and included partial fat necrosis (n = 3), partial donor skin necrosis (n = 1), and partial umbilical necrosis (n = 1). There were no total flap losses or incisional hernias. Patients were able to be discharged at an average of 7.45 days and return to normal activities or work at an average of 5 weeks. Two patients developed metastasis, and in these patients the average interval between TRAM flap reconstruction and metastasis was 1 year. The average satisfaction grade was 4 points.
Conclusion: TRAM flap reconstruction after mastectomy is an appropriate way to improve the patient’s postoperative physical appearance. The results of this study indicated that TRAM flap reconstruction after mastectomy is safe, with an acceptably low number of complications and can be performed by a single surgeon in conjunction with a mastectomy procedure; furthermore, the majority of patients were satisfied with their reconstructed breast.

Keywords: Immediate breast reconstruction, Transverse rectus abdominis myocutaneous flap (TRAM), Complications, Outcome