[Breast reconstruction with the free microvascular abdominal flap. Accessory reconstruction or gold standard?]

Long time results of breast reconstruction after ablative surgery with skin expander and prothesis is perceived as unsatisfactory by most patients. Breast reconstruction with autologous tissue however is connected with a high technical expenditure and especially in the case of the free TRAM-flap connected with the risk of total loss of the transplanted tissue. In view of the total effort in secondary interventions, and reduction of the collateral side, the autologous reconstruction proves to need less time, resources and hospital admissions already after a 2 year period. Minor revisions mark the long time course of breast reconstruction with expander and prothesis. Judging by the patients themselves they prefer the reconstruction with autologous tissue and in this subgroup microsurgical reconstruction yields the better results to the patient. Review shows that the microsurgical procedure allows the transfer of larger volumes and better positioning of the breast including a physiologic breast ptosis. TRAM-flap donorsites seem to yield equal results in dynamic as well as static exercise regardless of the microsurgical or pedicled technique. The review of our own 48 patients with 50 TRAM-flaps coincide with the review of the current literature.