Safety of immediate transverse rectus abdominis myocutaneous breast reconstruction for patients with locally advanced disease

Hypothesis: Immediate transverse rectus abdominis myocutaneous breast reconstruction combined with postoperative radiation therapy after mastectomy is safe and effective. Design: Retrospective case series. Setting: University-based teaching hospital. Patients: From January 1, 1996, through December 31, 2003, 252 patients underwent mastectomy and immediate transverse rectus abdominis myocutaneous flap reconstruction. Of those, 35 patients received postoperative radiation therapy (stage I, n = 1; II = 17; III = 15; IV, n = 2). Age range was 29 to 72 years (mean, 49.5 years). Follow-up was 1 to 8 years (mean, 48 months). Main Outcome Measures: Flap loss, fat necrosis, flap volume loss, adjuvant treatment delay, and need for additional surgery. Results: The rate of flap survival was 100%. Median operative time was 5.5 hours. Average hospital stay was 5.2 days. Fat necrosis occurred in 3 patients, with volume loss requiring additional surgery in 2 patients (6%). Postoperative adjuvant therapy was not significantly delayed (median interval, 32 days). With a median follow-up of 48 months, local recurrence was present in only 1 patient (3%), who underwent successful local salvage, and distant metastasis occurred in 4 patients (11%) Conclusions: Immediate transverse rectus abdominis myocutaneous breast reconstruction followed by radiation therapy is safe, with minimal morbidity and no significant change in tissue volume. Complications tend to be minor, not delaying adjuvant therapy. Immediate breast reconstruction should be considered after mastectomy, despite the need for postoperative radiation therapy.