[Breast reconstruction using the free TRAM flap in a private practice setting. A review of 20 cases]

The breast reconstruction is an integral part of the treatment for breast cancer after mastectomy. A lot of methods were described like the free TRAM flap reconstruction. The technical difficulty, the length of the procedure and the post-operative monitoring of this reconstruction make it as an alternative used generally in a hospital setting.

The goal of this retrospective study is to document the validity of this technique in the private practice setting.

Between 2003 and 2006, 20 patients were operated on for a breast reconstruction using a free TRAM flap by a double "melting-pot" surgical team in a private clinic in Tunisia. The average age was 43 years and the average delay for the breast reconstruction was 16 months after mastectomy. We have always used the same surgical technique: a free TRAM flap plugged on the internal mammary vessels. The arterial anastomosis was stitched by a thread and the venous anastomosis was done by using a microvascular anastomotic coupler. The average operating time was 4 hours. The average stay in the clinic was 5 days.

There was no total flap loss. We observed one partial necrosis that healed in 5 weeks with dressings, one hematoma that required a surgical evacuation at the second day and one case of abdominal wall weakness treated by a mesh repair at one year.

The breast reconstruction using a free TRAM flap is a reliable and safe technique that can be used without any difficulties in a private practice setting if it is made by a surgical team familiar with microsurgery and respecting its criteria with also a good management and strategy for aftercare.