Supakorn RojananinAdune RatanavichitrasinMahidol University2018-07-042018-07-041998-01-01Breast Journal. Vol.4, No.2 (1998), 96-1031075122X2-s2.0-0031924898https://repository.li.mahidol.ac.th/handle/20.500.14594/18598From January 1990 to June 1995, immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction of the breast after mastectomy for cancer was performed in 40 patients with the objective of improving the quality of life. The 40 cases included one malignant cystosarcoma phyllodes (MCP), two intraductal carcinomas, four mucinous carcinomas (T1-2N0), one lobular carcinoma (T2N1), and 32 invasive ductal carcinomas (T1-2 N0 = 19, T3N0 = 1, T1-2N1 = 9, T3N1 = 3). Modified radical mastectomy (MRM) was performed in all but one patient (MCP) who had subcutaneous mastectomy. A single pedicle TRAM flap was used for breast reconstruction in 36 cases and double pedicles in the remaining four cases. Since mid-1991, the mastectomy incision has been modified from elliptical incision to new skin-sparing incisions of various patterns depending on the tumor sites (n = 30). This change permitted a better cosmetic result and lessened the paresthetic area of the breast. Major complications were found in only 6 cases (20% skin flap necrosis in 1, major fat necrosis with discharge in 3, wound infection with foreign body in 1, and abdominal wound dehiscence in 1 case). The average postoperative hospital stay was 9 days (5-23 days). Adjuvant chemotherapy was given in 22 cases. All but two cases received the treatment within 1 month postoperatively (PO). Subsequent nipple reconstruction was accomplished in 18 cases using local skin flap in 16 and nipple sharing in 2 patients. There were two deaths from distant metastasis (ONE, also had local chest wall recurrence). In the other cases no evidence of disease was found. The follow- up periods ranged from 6 to 72 months. From our experience so far, we have found that, in early breast cancer patients, MRM with a skin-sparing incision and immediate TRAM flap reconstruction does not compromise the oncological sound, but improves the cosmetic result, provided that the patients receive a full course of treatment as planned.Mahidol UniversityMedicineArticleSCOPUS10.1046/j.1524-4741.1998.420096.x