Free Tissue Transfer From Anterior Abdominal Wall In Breast Reconstruction At The Same Session Of Modified Radical Mastectomy.

Abstract

Breast reconstruction surgeries represent modern era in recent surgery , the consept of removal of breast without reconstruction is widely not accepted . There is many techniques of breast reconstruction , and one of them is free tissue transfer from anterior abdominal wall ,. Free tissue transfer from anterior abdominal wall include freee TRAM flap or Ms TRAM flap or DIEAP flap or SIEA flap . Every one of these flap depent of certin blood supply which harvested with the flap and anastomose it with blood vessles at chest wall Every flap differ from other as threre are falps which include muscle others are not , also every one has each own characters , indication , techniques and complications. Free TRAM flap is good option for breast reconstruction and it is more better in results than pedicled TRAM flap, but it scarify with muscle from anterior abdominal wall which may cause hernia. DIEAP considered the best choice if done by qualified surgeon in qualified place and good moinitoring , as it does not scarifiy with mucle , so it can preserve the integrity of abdominal wall . SIEA flap has limited role , becaue of untrusted blood supply and it sometimes may be absent. Nipple and areola reconstruction is done at second stage with reduction mastopexy to other side, it has new various techniques as local falp or graft from other side or even tattoing , nipple projection can be maintained by multiple methods as cartilage graft or silicon rod . Complication of free tissue transfer from anterior abdominal wall depend on part of muscle which harvested from abdomen so , free TRAM morbidity rates more than Ms-TRAM and DIEP flap . Closure of abdominal wall after harvesting flap can be done by traditional method of abdominplasty closure , but is case Free TRAM falp , mesh is a must.