Outcome of Management of Local Recurrence after Immediate Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction

Background No consensus has been reached regarding the outcome of management of localrecurrence after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction.This study demonstrated the presentation, management, and outcomes of local recurrenceafter immediate TRAM breast reconstruction.Methods A comparison was conducted among 1,000 consecutive patients who underwentimmediate breast reconstruction with a pedicled TRAM flap (TRAM group) and 3,183 consecutivepatients who underwent only modified radical mastectomy without reconstruction (MRMgroup) from January 2001 to December 2009. The presentation, treatment, and outcomeincluding aesthetics and overall survival rate were analyzed.Results Local recurrences occurred in 18 (1.8%) patients (TRAM-LR group) who underwentTRAM breast reconstruction and 38 (1.2%) patients (MRM-LR group) who underwent MRMonly (P=0.1712). Wide excision was indicated in almost all the local recurrence cases. Skingraft was required in 4 patients in the MRM-LR group, whereas only one patient requireda skin graft to preserve the mound shape in the TRAM-LR group. The breast mound wasmaintained in all 17 patients that survived in the TRAM-LR group even after wide excision.The overall survival rate was 94.4% in the TRAM-LR group and 65.8% in the MRM-LR group(P=0.276).Conclusions Local recurrence after immediate TRAM flap breast reconstruction could bedetected without delay and managed effectively by multiple modalities without reducingoverall survival rates. Breast mound reconstruction with soft autologous tissue allowed forprimary closure in most of the cases. In all of the patients who survived, the contour of theirreconstructed breast remained.