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Delayed TRAM in Breast Reconstruction

Introduction: Breast reconstruction following modified radical mastectomy has evolved into either autogenous or implant depending reconstruction. In autogenous breast reconstruction TRAM (transverse rectus abdominal myocutaneous) flap was previously considered the best modality. However, an incidence of 30-40% complication rate was linked to this flap. Accordingly, many surgeons shifted to use flaps depending on microsurgery in breast reconstruction; among these flaps is DIEP flap which is most commonly used. The aim of this study is to prove that delay of TRAM flap is an efficient method to decrease complication rate of such flap to a minimum. Material and Methods: This is a retrospective study since 2010 till 2016, it involved 24 cases suffering from breast cancer and managed by modified radical mastectomy. All cases did delay breast reconstruction by delayed TRAM flap. The age varied from 40 years old to 65 years old with an average of 52.5 years old. All cases were obese BMI >30, 13 cases (54.1%) were diabetic, 10 cases (41.6%) had previous caesarean section, 2 cases (8.3%) had vertical abdominal wall scar. All patients went through a first stage of delay; after 2 to 3 weeks separation and inset of the flap was done. Results: Follow-up was done for a minimum of 1 month. All flaps survived completely with no major complication. Early complications varied from 3 cases (12.5%) had seroma, 2 cases (8.3%) had dehiscence at the lateral border from mastectomy flap, 2 cases (8.3%) had hardening, redness and hotness. Late complications, 2 cases (8.3%) had abdominal wall weakness. Conclusion: Tips in the delay and harvest of the flap were emphasized by lower number of complications in this group of high-risk patients. Delayed TRAM is a safe reliable procedure that ensures long term desired aesthetic outcome & less complication rate than DIEP free flap and TRAM.