Preoperative planning of unilateral breast reconstruction with pedicled transverse rectus abdominis myocutaneous (TRAM) flaps: a pilot study of perforator mapping

Alisha Fong; Hye-Sung Park; David A Ross; Warren M Rozen

doi:10.21037/gs-22-529

Preoperative planning of unilateral breast reconstruction with pedicled transverse rectus abdominis myocutaneous (TRAM) flaps: a pilot study of perforator mapping

Gland Surg. 2023 Mar 31;12(3):366-373. doi: 10.21037/gs-22-529. Epub 2023 Mar 13.

Authors

Alisha Fong^{1

2

3}, Hye-Sung Park^{1

2

3}, David A Ross^{1

2

3}, Warren M Rozen^{1

2}

Affiliations

¹ Department Surgery, Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Victoria, Australia.
² Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Victoria, Australia.
³ Department of Plastic and Reconstructive Surgery, Moorabbin Hospital, Monash Health, Victoria, Australia.

Abstract

Background: Pedicled transverse rectus abdominis myocutaneous (TRAM) flaps are well-established autologous reconstructive options for breast reconstruction. Preoperative computed tomographic angiography (CTA) has since become part of the routine workup in breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps. CTA provides an improved understanding of perforator anatomy which can facilitate optimal choice of hemiabdominal wall, and guide sheath harvest. Despite this knowledge, the role of preoperative CTA for breast reconstruction with the pedicled TRAM flap has not yet been established.

Methods: A consecutive cohort of patients undergoing breast reconstruction with pedicled TRAM flaps without preoperative imaging were compared to a similar cohort of consecutive patients undergoing the same procedure with the use of preoperative CTA. Both flap and donor outcomes were assessed.

Results: Thirty-four consecutive patients undergoing ipsilateral breast reconstruction with pedicled TRAM flaps were included. There was no statistical difference in the operative times or outcomes between the two groups. There were no complete flap losses in either group.

Conclusions: The use of preoperative CTA may help to guide surgical technique and provide the surgeon with greater confidence intraoperatively, however, this study did not show significant change in operative outcomes. Further study and risk/benefit analysis may better highlight the role of CTA in pedicled TRAM flap planning.

Keywords: Rectus abdominis; angiography; computed tomographic angiography (CTA); inferior epigastric artery; transverse rectus abdominis myocutaneous flap (TRAM flap).