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J Surg Case Rep 2022 May 23;2022(5):rjac135. Epub 2022 May 23.

Division of General Surgery, Kingston Public Hospital, Kingston, Jamaica.

The pedicled transverse rectus abdominis myocutaneous (TRAM) flap is an infrequently performed procedure relative to the more current microsurgical free tissue transfers in most centres around the world. However, in resource-limited centres where procedures requiring microsurgical intervention are rarely employed, the pedicled TRAM whose vascular axis is that of the superior epigastric artery, is an invaluable tool in the plastic surgeon's armamentarium both for breast reconstruction and chest wall soft tissue resurfacing. This a report of a case of variable anatomical vascular perforating branch of the internal thoracic artery, which was encountered while using a TRAM to resurface a chest wall defect after mastectomy was performed for locally advanced breast cancer. Read More

Breast Dis 2022 ;41(1):267-272

Department of Breast and Endocrine Surgery, Royal Adelaide Hospital, South Australia, Australia.

Purpose: Immediate autologous breast reconstruction (IABR) offers fewer surgeries with better psychosocial, quality of life and aesthetic outcomes. In high-risk patients or those with locally advanced breast cancer (LABC), adjuvant postmastectomy radiotherapy decreases local recurrence and improves survival. However, it has negative effects on the reconstructed flap. Read More

J Plast Reconstr Aesthet Surg 2022 Apr 27. Epub 2022 Apr 27.

Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.

Background: While breast reconstruction often improves the quality of life of patients with locally advanced breast cancer, there is still no consensus on its safety. This retrospective report aimed to verify the safety of immediate breast reconstruction for locally advanced breast cancer.

Methods: We retrospectively analyzed 500 breast cancer surgeries performed between January 2005 and December 2019 at our hospital, including 120 immediate breast reconstructions. Read More

Microsurgery 2022 Mar 31. Epub 2022 Mar 31.

Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Background: Women undergoing immediate breast reconstruction without radiation therapy have reconstruction methods available with uncertain long-term costs associated with complications requiring surgery and revisions. We evaluated cost-effectiveness of nine methods of immediate breast reconstruction for women with localized breast cancer.

Methods: Markov modeling was performed over 10-years for unilateral/bilateral breast reconstructions from healthcare/societal perspectives. Read More

J Pers Med 2022 Mar 16;12(3). Epub 2022 Mar 16.

Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.

Background: Vascular patency is the key element for high flap survival rates. The purpose of this study was to assess and compare the blood flow characteristics of deep inferior epigastric perforator (DIEP) and muscle-sparing transverse rectus abdominis musculocutaneous (ms-TRAM) flaps for autologous breast reconstruction.

Methods: This prospective clinical study combined Transit-Time Flowmetry and microvascular Indocyanine Green Angiography for the measurement of blood flow volume, vascular resistance, and intrinsic transit time. Read More

Plast Reconstr Surg Glob Open 2022 Jan 25;10(1):e4037. Epub 2022 Jan 25.

Department Surgery, Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, Victoria, Australia.

The deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction has been popularized over the transverse rectus abdominis myocutaneous (TRAM) flap, as it spares rectus abdominis muscle and has low donor site morbidity. This progression to muscle preservation, however, has been associated with an increased difficulty in vascular dissection, perfusion-related complications, and lengthier surgical times. We pilot a technique that may achieve the benefits of the TRAM flap in terms of ease of dissection and vascularity, with the benefits of the DIEP flap in terms of maintaining rectus abdominis continuity. Read More

Medicina (Kaunas) 2022 Jan 12;58(1). Epub 2022 Jan 12.

Department of Specialized Surgeries, Graduated School, Tokyo Medical and Dental University, Tokyo 1138519, Japan.

In the treatment of the special type of breast cancer (STBC), the choice of chemotherapeutic agents is often based on the characteristic features of the histological type. On the other hand, the surgical strategy is usually determined by the tumor size and presence of lymph node metastasis, and the indication for immediate reconstruction is rarely discussed based on the histological type. The prognoses of STBC and invasive ductal carcinoma of the breast (IDC) patients who underwent subcutaneous mastectomy (SCM) with immediate reconstruction at our institution were compared. Read More

J Plast Reconstr Aesthet Surg 2022 03 14;75(3):1117-1122. Epub 2021 Nov 14.

The Section of Surgical Patho-physiology, Rigshospitalet, Copenhagen University Hospital, Denmark.

Background: In 2015, we published one of the first reports using an enhanced recovery protocol (ERP) in microsurgery, and in 2016, our final ERP setup in autologous breast reconstruction (ABR) using free abdominal flaps. We showed that by adhering to a few simple, easy to measure, functional discharge criteria, it was possible to safely discharge the patients by the third postoperative day (POD). However, one of the challenges of interpreting studies using ERP in ABR is the often heterogenous patient populations and the need to clearly distinguish between primary and secondary and unilateral and bilateral reconstructions. Read More

J Clin Med 2021 Nov 5;10(21). Epub 2021 Nov 5.

Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia.

Background: Closed incision negative pressure therapy (ciNPT) may reduce the rate of wound complications and promote healing of the incisional site. We report our experience with this dressing in breast reconstruction patients with abdominal free flap donor sites.

Methods: A retrospective cohort study was conducted of all patients who underwent breast reconstruction using abdominal free flaps (DIEP, MS-TRAM) at a single institution (Royal Melbourne Hospital, Victoria) between 2016 and 2021. Read More

Ann Plast Surg 2021 11;87(5):542-546

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA.

Background: Reinforcement of the abdominal wall with synthetic mesh in autologous breast reconstruction using abdominal free tissue transfer decreases the risk of bulging and herniation. However, the impact of the plane of mesh placement on donor site complications has not yet been investigated.

Methods: We performed a retrospective analysis of 312 patients who had undergone autologous breast reconstruction with muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps or deep inferior epigastric perforator (DIEP) flaps as well as polypropylene mesh implantation at the donor site. Read More

J Plast Reconstr Aesthet Surg 2022 Jan 17;75(1):52-60. Epub 2021 Aug 17.

Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054 Erlangen, Bayern, Germany.

Background: There is still no consensus regarding the ideal zoning in abdominal-based autologous breast reconstruction using free DIEP or ms-TRAM flaps. In particular, the perfusion pattern of the flap according to the number of perforators used and their location remains controversial. In this study, the perfusion of free DIEP and ms-TRAM flaps is assessed intraoperatively and analyzed with regard to different perfusion patterns. Read More

Gland Surg 2021 Jul;10(7):2192-2199

Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Level 5, E Block, Monash Medical Centre, Clayton, Victoria, Australia.

Background: Modern imaging technologies, such as computed tomographic angiography (CTA), can be useful for preoperative assessment in deep inferior epigastric artery perforator (DIEP) flap surgery. Planning perforator flap design can lead to improved surgical efficiency. However, current imaging modalities are limited by being displayed on a two-dimensional (2D) surface. Read More

Plast Reconstr Surg Glob Open 2021 Jul 28;9(7):e3704. Epub 2021 Jul 28.

Division of Plastic Surgery, University of British Columbia, Kelowna General Hospital, Kelowna, BC, Canada.

Performing delayed reconstruction to a unilateral breast while simultaneously performing a balancing procedure on the contralateral side can be the most difficult situation to achieve symmetry. We present here a novel approach to free TRAM-based breast reconstruction using reverse planning and subunit principles with simultaneous balancing reduction mastopexy and immediate nipple reconstruction.

Methods: A retrospective chart review and a BREAST-Q questionnaire of a single surgeon's practice was performed to compare revision rates and patient satisfaction following Destination Design msTRAM reconstruction compared with a historical cohort of patients who received traditional free TRAM reconstruction. Read More

Ann R Coll Surg Engl 2022 Apr 24;104(4):e119-e121. Epub 2021 May 24.

Broomfield Hospital, UK.

Cryolipolysis refers to the sub-physiological cooling of regional body parts (typically the abdomen) in order to reduce the volume of adipose tissue. It provides a non-invasive alternative to procedures such as liposuction, which have traditionally been considered as relative contraindications for future abdominal free flap-based reconstructions. We describe the first case of a patient undergoing skin-sparing mastectomy and a muscle-sparing transverse rectus abdominis musculocutaneous (msTRAM) free flap breast reconstruction, following cryolipolysis therapy. Read More

Aesthetic Plast Surg 2021 12 23;45(6):2618-2630. Epub 2021 Apr 23.

Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China.

Background: Previous data were not conclusive on the safety of gestation in patients whose abdominal flaps were earlier harvested. We performed a meta-analysis to evaluate the abdominal wall complications and birth mode of pregnancy in post-TRAM or post-DIEP harvested individuals.

Methods: A literature search was performed using the PubMed, Embase, Scopus, and Google scholar database. Read More

Plast Surg (Oakv) 2021 Feb 20;29(1):16-20. Epub 2020 Jul 20.

Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA.

Introduction: Abdominal wall morbidity after microsurgical breast reconstruction is an important consideration for patients and surgeons. Previous studies are limited by multiple mesh locations or types. In this study, we evaluate specifically subfascial polypropylene mesh placement to determine a more definitive complication rate and basis for objective comparison. Read More

Plast Reconstr Surg Glob Open 2020 Oct 29;8(10):e3120. Epub 2020 Oct 29.

Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.

Introduction: Transverse rectus abdominis myocutaneous (TRAM) and deep inferior epigastric artery perforator (DIEP) flaps are the most common abdominally based breast reconstruction procedures. Each technique has its advantages and disadvantages; however, how morbidity relates to satisfaction is not well-understood. Our aim was to compare complications and patient-reported outcomes following pedicled TRAM (pTRAM), free TRAM (fTRAM), and DIEP flaps to guide flap selection. Read More

Arch Plast Surg 2020 Sep 15;47(5):428-434. Epub 2020 Sep 15.

Division of Plastic Surgery, Stanford University, Palo Alto, CA, USA.

Background: Three-dimensional (3D) model printing improves visualization of anatomical structures in space compared to two-dimensional (2D) data and creates an exact model of the surgical site that can be used for reference during surgery. There is limited evidence on the effects of using 3D models in microsurgical reconstruction on improving clinical outcomes.

Methods: A retrospective review of patients undergoing reconstructive breast microsurgery procedures from 2017 to 2019 who received computed tomography angiography (CTA) scans only or with 3D models for preoperative surgical planning were performed. Read More

Cureus 2020 Jun 22;12(6):e8776. Epub 2020 Jun 22.

Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA.

The free transverse rectus abdominis myocutaneous (fTRAM) flap is a frequently used option for autologous breast reconstruction, typically based on deep inferior epigastric vessels anastomosed to either the axillary or internal mammary systems. The distal portion of the fTRAM flap is routinely discarded prior to anastomosis, due to tenuous blood supply in the vascular territory most distal to the pedicle. This becomes problematic in cases that require use of the entire flap, such as in thin patients with large soft-tissue defects. Read More

Clin Breast Cancer 2020 10 23;20(5):402-407. Epub 2020 May 23.

Division of Breast Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong. Electronic address:

Introduction: Immediate breast reconstruction offers cosmetic and psychological advantages post-mastectomy. There are various options of reconstruction, and this study aims to evaluate the associated complications.

Patients And Methods: This is a single-center retrospective study analyzing data from January 1, 2008 to December 31, 2017 for immediate breast reconstruction procedures post-mastectomy performed at an academic breast unit. Read More

Eur J Obstet Gynecol Reprod Biol 2020 Sep 30;252:166-173. Epub 2020 May 30.

Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650, Antwerp, Belgium.

Objective: Breast reconstructions with perforator flaps from the lower abdomen, commonly known as Deep Inferior Epigastric artery Perforator flap (DIEP-flap), have become the golden standard for autologous breast reconstruction after breast amputation. During this surgical procedure multiple challenging steps are encountered such as the selection of a suitable perforator that provides sufficient blood supply for the flap, surgical dissection of the chosen perforator, determination of perfusion area of the chosen perforator, microsurgical anastomosis, flap inset and shaping the flap into a breast. The current gold standard for perforator mapping is Computed Tomography Angiography (CTA). Read More

Handchir Mikrochir Plast Chir 2020 Apr 7;52(2):83-87. Epub 2020 Apr 7.

Agaplesion Diakonie-Klinikum Hamburg gGmbH Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie.

Introduction: In recent decades, the internet has become one of the most important sources of information for patients. How substantial are the possibilities to find out about breast reconstruction on the homepages of university hospitals in Germany? Is there information about plastic surgery with its spectrum of modern reconstructive possibilities?

Methods: A total of 35 homepages of university breast centres in Germany was analysed for the indication of cooperation with a plastic surgeon or a department for plastic surgery and their links, with information on reconstructive possibilities such as implant reconstruction, autologous soft tissue reconstruction with pedicled and free flaps as well as lipofilling.

Results: A plastic surgeon or a cooperating department is mentioned on 49 % of the homepages. Read More

Front Oncol 2020 5;10:177. Epub 2020 Mar 5.

Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Erlangen, Germany.

Breast cancer is the most common malignancy in women. The interdisciplinary treatment is based on the histological tumor type, the TNM classification, and the patient's wishes. Following tumor resection and (neo-) adjuvant therapy strategies, breast reconstruction represents the final step in the individual interdisciplinary treatment plan. Read More

J Plast Reconstr Aesthet Surg 2019 Dec 7;72(12):1923-1929. Epub 2019 Sep 7.

Division of Plastic and Reconstructive Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 770 Welch Road, Suite 400, Stanford, Palo Alto, CA 94304, United States. Electronic address:

Over the past several decades, technical advances in breast reconstruction have resulted in the development of flaps that are aimed at progressively decreasing abdominal wall morbidity. There is, however, ongoing controversy related to the superiority of deep inferior epigastric perforator (DIEP) flaps over muscle-sparing TRAM (MS-TRAM) flaps. Hence, the question remains unanswered as to which approach should be considered the standard of care, and more importantly, whether the rate of DIEP flap utilization should be considered a quality metric in breast reconstruction. Read More

Cardiovasc Diagn Ther 2019 Aug;9(Suppl 1):S131-S142

Department of Radiology, UT Health Science Center, San Antonio, TX, USA.

Perforator flap-based breast reconstruction in a post mastectomy patient requires dissection of the artery-vein bundle (perforators) responsible for perfusion of the subcutaneous fat and skin of the flap. Traditionally, these reconstructions were performed with the transverse rectus abdominis myocutaneous (TRAM) flap, but autologous breast reconstruction using muscle sparing free flaps has become steadily more popular in recent years. Preoperative imaging to locate and evaluate candidate perforators has become an essential step before patients undergo the microsurgical procedure. Read More

Ann Plast Surg 2020 03;84(3):293-299

From the Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan.

Background: Despite improvements in the early detection of breast cancer, locally advanced breast cancer (LABC) involving the chest wall exists in developing countries. Surgical resection remains a controversial management option. This study aims to demonstrate the value of chest wall reconstructive techniques for large LABC defects and report long-term outcomes. Read More

Gland Surg 2019 Jun;8(3):242-248

St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, UK.

Background: The plasmakinetic cautery is a surgical dissection instrument that combines scalpel-like cutting precision with electrocautery-like haemostasis properties, and operates at lower temperatures (40-170 °C) than conventional electrocautery (200-350 °C). The aim of this study is to evaluate the clinical benefits of using plasmakinetic cautery in abdominal free flap dissection for breast reconstruction.

Methods: Forty women undergoing abdominal-based microsurgical breast reconstruction (DIEP/MS-TRAM) were randomized to plasmakinetic cautery (n=20) or conventional electrocautery (n=20) for dissection of the abdominal free flap. Read More

Acta Chir Belg 2020 Dec 8;120(6):375-382. Epub 2019 Jul 8.

Department of Plastic Surgery, Gatot Soebroto Army Central Hospital, Jakarta, Indonesia.

Background: Breast reconstruction can ease the psychological burden in breast cancer patients that have undergone mastectomy. The aim of our study is to collect the latest evidences to summarize whether pedicled TRAM (pTRAM) is non-inferior in terms of patient satisfaction and complications to free TRAM (fTRAM) so that it may be used in region with limited resources.

Methods: We performed a comprehensive search on studies that compared pTRAM and fTRAM flap from several databases. Read More

Ann Plast Surg 2019 12;83(6):e59-e67

From the Department of Plastic and Reconstructive Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan.

Background: We compare the vascular territory of free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps, deep inferior epigastric perforator (DIEP) flaps, and crossover anastomosis (CA) flaps using intraoperative ex vivo angiography. We also use ex vivo angiography to analyze the vascular architecture of the MS-TRAM flap.

Methods: Our study includes 84 lower abdominal free flaps: MS-TRAM, DIEP-1 (1 perforator), DIEP-2 (2 perforators), and CA. Read More