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Locoregional Recurrence after Mastectomy with Immediate Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Reconstruction
Annals of Surgical Oncology, 04/10/2012
Patterso SG et al. – All TRAM LRR were detected by routine physical examination by the patient or the surgeon. The findings suggest that routine history and clinical breast examination of the breast reconstructed with a TRAM flap along with patient self–awareness are reliable in the diagnosis of LRR.
Methods- Authors retrospectively reviewed patients undergoing immediate TRAM reconstruction for breast cancer who were diagnosed with LRR.
- They identified 18 LRR (4.6 %) in 18 of 390 patients who underwent immediate TRAM reconstructions for breast cancer from 1998 to 2008.
- The median follow–up was 69.2 months. The mean age at time of mastectomy was 49.5 years.
- All LRR were detected by physical examination.
- The LRR occurred in the TRAM subcutaneous tissue (n = 9), five in the ipsilateral axillary lymph node and four in the supraclavicular lymph node.
- Of the 18 patients who developed LRR, 14 (77.7 %) presented with stage 0–1–2 and 4 (22.2 %) with stage 3 disease at the time of the original mastectomy.
- The average time for a LRR to present was 35.8 months after initial mastectomy and reconstruction.
- For patients who initially presented with stage 3 disease, the average time to LRR was shorter (22.9 months).
- Nine patients (50.0 %) were found to have metastatic disease at the time of the LRR, and 6 (33.3 %) died of disease.
