A TRAM flap design refinement for use in delayed breast reconstruction.

Hdl Handle:
http://hdl.handle.net/10147/200961
Title:
A TRAM flap design refinement for use in delayed breast reconstruction.
Authors:
Patel, A J K; Kulkarni, M; O'Broin, E S
Affiliation:
Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital (Cambridge University Hospitals NHS Trust), Cambridge, UK. aj.patel@virgin.net
Citation:
A TRAM flap design refinement for use in delayed breast reconstruction. 2009, 62 (9):1135-9 J Plast Reconstr Aesthet Surg
Journal:
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
Issue Date:
Sep-2009
URI:
http://hdl.handle.net/10147/200961
DOI:
10.1016/j.bjps.2008.03.015
PubMed ID:
18590989
Abstract:
Autologous breast reconstruction following mastectomy is commonly achieved using the free Transverse Rectus Abdominis Myocutaneous (TRAM) flap. Since its first description, refinements and modifications have resulted in improved operative techniques and more aesthetically pleasing reconstructions. Pre-operative flap design, however, is a relatively new concept that has not received much attention in the literature. Patients who undergo breast reconstruction may have large, ptotic contralateral breasts. In these patients there is a tendency to raise a large abdominal flap in an attempt to achieve symmetry, or simply a larger breast. This has the potential to lead to tight closure of the abdomen and the risk of subsequent wound problems. Reconstructions that are too small or have inadequate ptosis commit the patient to contralateral breast surgery to achieve symmetry. Pre-operatively designing the flap, using a template created from the opposite breast, can help achieve a good match, often reducing the need for contralateral breast surgery. Even when contralateral breast reduction surgery is planned in advance, many of these patients still require, and prefer, a large reconstruction in order to achieve a well-proportioned result. We present a design template that addresses these particular issues and in the senior author's hands has proved to be a very effective technique. Our technique allows raising an abdominal flap of less vertical height than traditionally used (thus reducing the risk of tight abdominal closure) and incorporates an inverted V-shaped flap of skin from the inferior mastectomy skin flap into the reconstruction. This allows more flap tissue to be available to fill the upper poles of the reconstructed breast and at the same time produces good ptosis.
Item Type:
Article
Language:
en
Description:
Autologous breast reconstruction following mastectomy is commonly achieved using the free Transverse Rectus Abdominis Myocutaneous (TRAM) flap. Since its first description, refinements and modifications have resulted in improved operative techniques and more aesthetically pleasing reconstructions. Pre-operative flap design, however, is a relatively new concept that has not received much attention in the literature. Patients who undergo breast reconstruction may have large, ptotic contralateral breasts. In these patients there is a tendency to raise a large abdominal flap in an attempt to achieve symmetry, or simply a larger breast. This has the potential to lead to tight closure of the abdomen and the risk of subsequent wound problems. Reconstructions that are too small or have inadequate ptosis commit the patient to contralateral breast surgery to achieve symmetry. Pre-operatively designing the flap, using a template created from the opposite breast, can help achieve a good match, often reducing the need for contralateral breast surgery. Even when contralateral breast reduction surgery is planned in advance, many of these patients still require, and prefer, a large reconstruction in order to achieve a well-proportioned result. We present a design template that addresses these particular issues and in the senior author's hands has proved to be a very effective technique. Our technique allows raising an abdominal flap of less vertical height than traditionally used (thus reducing the risk of tight abdominal closure) and incorporates an inverted V-shaped flap of skin from the inferior mastectomy skin flap into the reconstruction. This allows more flap tissue to be available to fill the upper poles of the reconstructed breast and at the same time produces good ptosis.
MeSH:
Abdominal Muscles; Breast; Esthetics; Female; Humans; Mammaplasty; Mastectomy; Surgical Flaps; Time Factors; Wound Healing
ISSN:
1878-0539

Full metadata record

DC FieldValue Language
dc.contributor.authorPatel, A J Ken
dc.contributor.authorKulkarni, Men
dc.contributor.authorO'Broin, E Sen
dc.date.accessioned2012-01-09T16:10:13Z-
dc.date.available2012-01-09T16:10:13Z-
dc.date.issued2009-09-
dc.identifier.citationA TRAM flap design refinement for use in delayed breast reconstruction. 2009, 62 (9):1135-9 J Plast Reconstr Aesthet Surgen
dc.identifier.issn1878-0539-
dc.identifier.pmid18590989-
dc.identifier.doi10.1016/j.bjps.2008.03.015-
dc.identifier.urihttp://hdl.handle.net/10147/200961-
dc.descriptionAutologous breast reconstruction following mastectomy is commonly achieved using the free Transverse Rectus Abdominis Myocutaneous (TRAM) flap. Since its first description, refinements and modifications have resulted in improved operative techniques and more aesthetically pleasing reconstructions. Pre-operative flap design, however, is a relatively new concept that has not received much attention in the literature. Patients who undergo breast reconstruction may have large, ptotic contralateral breasts. In these patients there is a tendency to raise a large abdominal flap in an attempt to achieve symmetry, or simply a larger breast. This has the potential to lead to tight closure of the abdomen and the risk of subsequent wound problems. Reconstructions that are too small or have inadequate ptosis commit the patient to contralateral breast surgery to achieve symmetry. Pre-operatively designing the flap, using a template created from the opposite breast, can help achieve a good match, often reducing the need for contralateral breast surgery. Even when contralateral breast reduction surgery is planned in advance, many of these patients still require, and prefer, a large reconstruction in order to achieve a well-proportioned result. We present a design template that addresses these particular issues and in the senior author's hands has proved to be a very effective technique. Our technique allows raising an abdominal flap of less vertical height than traditionally used (thus reducing the risk of tight abdominal closure) and incorporates an inverted V-shaped flap of skin from the inferior mastectomy skin flap into the reconstruction. This allows more flap tissue to be available to fill the upper poles of the reconstructed breast and at the same time produces good ptosis.en
dc.description.abstractAutologous breast reconstruction following mastectomy is commonly achieved using the free Transverse Rectus Abdominis Myocutaneous (TRAM) flap. Since its first description, refinements and modifications have resulted in improved operative techniques and more aesthetically pleasing reconstructions. Pre-operative flap design, however, is a relatively new concept that has not received much attention in the literature. Patients who undergo breast reconstruction may have large, ptotic contralateral breasts. In these patients there is a tendency to raise a large abdominal flap in an attempt to achieve symmetry, or simply a larger breast. This has the potential to lead to tight closure of the abdomen and the risk of subsequent wound problems. Reconstructions that are too small or have inadequate ptosis commit the patient to contralateral breast surgery to achieve symmetry. Pre-operatively designing the flap, using a template created from the opposite breast, can help achieve a good match, often reducing the need for contralateral breast surgery. Even when contralateral breast reduction surgery is planned in advance, many of these patients still require, and prefer, a large reconstruction in order to achieve a well-proportioned result. We present a design template that addresses these particular issues and in the senior author's hands has proved to be a very effective technique. Our technique allows raising an abdominal flap of less vertical height than traditionally used (thus reducing the risk of tight abdominal closure) and incorporates an inverted V-shaped flap of skin from the inferior mastectomy skin flap into the reconstruction. This allows more flap tissue to be available to fill the upper poles of the reconstructed breast and at the same time produces good ptosis.-
dc.language.isoenen
dc.subject.meshAbdominal Muscles-
dc.subject.meshBreast-
dc.subject.meshEsthetics-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshMammaplasty-
dc.subject.meshMastectomy-
dc.subject.meshSurgical Flaps-
dc.subject.meshTime Factors-
dc.subject.meshWound Healing-
dc.titleA TRAM flap design refinement for use in delayed breast reconstruction.en
dc.typeArticleen
dc.contributor.departmentDepartment of Plastic and Reconstructive Surgery, Addenbrooke's Hospital (Cambridge University Hospitals NHS Trust), Cambridge, UK. aj.patel@virgin.neten
dc.identifier.journalJournal of plastic, reconstructive & aesthetic surgery : JPRASen
dc.description.provinceMunster-
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