BREAST RECONSTRUCTION WITH LATISSIMUS DORSI FLAP AND TRANSVERSE RECTUS ABDOMINIS MYOCUTEANOUS FLAP (TRAM) AFTER MASTECTOMY

Abstract

reast cancer has been described in written records for millennia; it knows no racial/ethnic, socioeconomic, health, regal, celebrity, political, cultural, geographic, or temporal boundaries.The breast has been depicted in some of our most treasured and ancient art and literature. For the ancients, ―breast cancer was cancer‖.Other cancers surely existed but those were not readily seen or appreciated. The treatment of breast cancer has become increasingly complex as more options have become available to patients. A multidisciplinary approach to breast cancer care, including the involvement of an oncologic surgeon, plastic surgeon, medical oncologist, radiation oncologist, mammographer, and often genetic counselor, is critical to ensure that the patient achieves an optimal outcome. The role of breast reconstruction often plays a crucial role in the patient‘s recovery and has a significant positive impact on their psychological well-being. Breast reconstruction following mastectomy is now considered an integralpart of the modern management of breast cancer that should be offered to all patients without significant co-morbidity. Depending on the suitability of the patient, there B Summary and Conclusion 166 are also a wide range of reconstructive options, including autologous and implant based techniques, all of which must be offered, even if this cannot be carried out locally. The choice of breast reconstruction depends on the characteristics of the mastectomy defect, the size and shape of the contralateral breast, and the condition and desires of the patient. Equally important is the experience of the surgeon. Latissimus dorsi (LD) myocutaneous flaps, first described by Tassini, have been used in various reconstructive procedures for decades.In the setting of immediate or delayed breast reconstruction. LD flaps can be customized, with variations that include full muscle myocutaneous, split-muscle myocutaneous, muscle only, and skin-and-fat-only flaps. The transverse rectus abdominis (TRAM) flap was introduced 1982 by Hartrampf. Since this time breast reconstruction with autologous tissue and in particular the TRAM flap has undergone continuous refinements. Today the procedure is widely accepted throughout the world. Authors have described it as the most ingenious procedure ever devised in reconstructive plastic surgery. Many variations and modifications have been applied to the original procedure of the superiorly based unipedicle TRAM Summary and Conclusion 167 flap. Today the procedure is offered as a pedicled or microsurgical free tissue transfer. The blood supply of the superior pedicle can be enhanced by the strategy of surgical delay with ligation of the inferior vascular pedicle. Studies have been undertaken to determine whether an ipsilateral or contralateral pedicled TRAM flap is preferable.