Assessment of TRAM aesthetics: the importance of subunit integration

Characterization of optimal aesthetics in transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction is a challenge that even the most experienced breast surgeon faces. Aesthetic assessment in breast surgery has attempted to evaluate the reconstructed breast either as one cohesive entity or as a sum of its parts. The authors propose that the most advantageous assessment involves looking at the reconstructions in terms of aesthetic components, not necessarily in visual subunits.

The authors investigated the responses of five physicians and 12 nonphysician evaluators using various methods of aesthetic assessment, including, most importantly, a visual analogue scale survey. Pearson's correlation and intraclass correlation analyses were performed using SAS software.

Their analysis determined that while all components of TRAM reconstruction were important, symmetry, contour, and breast positioning were consistently named the most important components of breast reconstruction. When the breast reconstruction was divided into aesthetic subunits, there was a high degree of correlation between the overall score and the subunit scores (r = 0.81: r > 0.6 for good correlation).

From these assessments, the authors derived a set of aesthetic rules for TRAM flap reconstruction. They believe that methodical application of these rules on a consistent basis can lead to the production of maximal aesthetic outcomes in TRAM breast reconstruction.