TRAM flaps: a reconstructive option after bilateral nipple-sparing total mastectomy.

BACKGROUND: Transverse rectus abdominis musculocutaneous (TRAM) flaps have commonly been used as a reconstructive option after total mastectomy or modified radical mastectomy, but they can also serve as an appropriate alternative after bilateral nipple-sparing total mastectomy. In this study, performed from 1992 to 2002, 16 patients underwent TRAM flap breast reconstruction after bilateral nipple-sparing total mastectomy.

METHODS: The indications for bilateral nipple-sparing total mastectomy all involved benign breast disease; these patients were evaluated using a health outcomes study and the aesthetic evaluations of four judges using postoperative photographs. One patient had free flaps and 15 patients received pedicled flaps. Eleven patients had secondary reconstruction with bilateral TRAM flaps after implant removal, and five patients underwent immediate reconstruction with bilateral TRAM flaps.

RESULTS: Patients reported satisfactory physical and emotional functioning after the surgery without any significant detrimental effects on quality of life. Follow-up ranged from 3 to 90 months (median follow-up, 21 months). The cosmetic outcome of the reconstructed breast after bilateral nipple-sparing total mastectomy yielded fair to excellent results in the majority (80 percent) of patients.

CONCLUSIONS: Bilateral nipple-sparing total mastectomy remains an option for women with symptomatic breast conditions or with a high risk of familial breast cancer. Autologous tissue remains a reasonable alternative for reconstruction after bilateral nipple-sparing total mastectomy in the appropriately selected patient. To date, all patients in the study have remained free of breast cancer (range, 2 to 21 years).