Evaluation of Delayed Pedicled TRAM Flap for Breast Reconstruction in High Risk Patients

Background: Breast reconstruction after mastectomy is among the most critical decisions for both the surgeon and the patient. Transverse rectus abdominis musculocutaneous (TRAM) flap has gained increased popularity and has become the standard for autogenous breast reconstruction. Despite the success with TRAM flap, it still has ischemic-related complication in high risk patients. Aims: To evaluate delayed TRAM flap for breast reconstruction in high risk patients. Patients and methods: Between June 2017 to June 2019, 8 female patients with age ranging between 28-55 years were presented to us with history of modified radical mastectomy. Those patients were subjected to two stage operation. The first stage involved delay of the TRAM flap and second stage involved transfer of the contralateral TRAM flap to reconstruct the breast. Results: 7 out of 8 patients had achieved satisfactory result regarding volume and shape of reconstructed breast with no flap necrosis, only in one of our patient had partial flap necrosis which was treated with simple surgical debridement with no further sequelae. Conclusion and recommendation: Delayed TRAM flap showed to be effective in reducing risk of flap necrosis in high risk patients with good and pleasing aesthetic result.