Autologous Flap for Breast Reconstruction: An Iranian Breast Surgeon's Experience

Introduction & Breast cancer is the most common female cancer and modified radical mastectomy is one of the most standard procedure that is used by general surgeons. Mastectomy instead of change in shoulder girdle and spinal column, can change body image of patients, so some of them return for breast reconstruction and the type of this surgery has been chosen according to skin quality, Radiotherapy, pectoral muscle atrophy, surgical history.
This study is the result of 54 breast reconstructions by autologous TRAM and Lattismus Dorsi flap plus implant at 6 years in one hospital by one surgical team. Unipedicled TRAM flap that is based on the superior epigastric artery and in this procedure lower abdominal skin, subcutaneous tissue and Rectus muscle is rotated from upper abdominal tunnel. Lattismus Dorsi muscle and skin of posterior chest wall is rotated based on Thoracodorsal vessels for coverage of implant.
From 54 patients, TRAM flap was done on 23 (42.5%) patients, 4 partial necrosis (17.3%) was seen in this group. Lattismus Dorsi flap plus implant was done for 31 patients (57.4%) and only one partial necrosis was reported in this group. There wasn’t any total necrosis in each group. In only one patient for correction of asymmetry, fat injection was done in reconstructed breast for increase the size of flap.
Satisfaction estimation was done by calculation of number 1 to 4 and the result showed 80% of patients were chosen 3 or 4 and satisfied from the esthetic result and correction of their body Image, so few of them return for nipple areola reconstruction. Areola was created by Tattoo and nipple by skin flap.