Breast Reconstruction with a Muscle-Sparing Free Transverse Rectus Abdominis Myocutaneous Flap: Comparison between Immediate and Delayed Groups Chi-Feng Huang, MD; Ming-Huei Cheng, MD; Shin-Cheh Chen 1 , MD; Yung-Feng Lo 1 , MD; Ta-Sen Yeh 1 , MD; Samuel H.T. Chen, MD; Wei-Chao Huang, MD; Fu-Chan Wei, MD Background: Breast reconstruction offers not only physical but also psychological rehabil- itation. Autologous tissue transfer is a good option for breast reconstruction. The purpose of this study was to investigate the success rate, complications, and cosmetic outcomes following use of a muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap for breast reconstruction. Methods: Between August 1999 and February 2001, 15 consecutive patients underwent breast reconstruction using a muscle-sparing free TRAM flap after a mastec- tomy. Ten patients received mastectomies and immediately underwent breast reconstruction using muscle-sparing free TRAM flaps at Chang Gung Memorial Hospital. The remaining 5 patients first received a modified radi- cal mastectomy and then underwent breast reconstruction. Results: The mean age of patients was 43.9 (range, 32 to 50) years. Ten patients (67%) underwent immediate reconstructions, and 5 (23%) underwent delayed reconstructions. The overall success rate was 93.3%. Postoperative complications included 1 abdominal seroma and 1 small area of breast fat necrosis. Six of 10 patients with immediate reconstruction underwent both adjuvant chemotherapy and hormone therapy, while 3 patients received only chemotherapy. None of these adjuvant therapies were delayed by the recon- structive surgery. At a mean follow-up of 26.7 months, no local recurrence had been found, and 93% of patients were satisfied with the esthetic results. Conclusions: A muscle-sparing free TRAM flap is a good option for breast reconstruction. Both the success rate and patient satisfaction are high. The subsequent adju- vant therapy need not be delayed following immediate reconstruction. (Chang Gung Med J 2004;27:275-82) Key words: muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap, mastectomy, breast reconstruction. Paper presented at the Annual Meeting of Surgical Association, R.O.C. March 24, 2002, Kaohsiung, Taiwan. From the Department of Plastic Surgery, 1 Department of General Surgery, Chang Gung Memorial Hospital, Taipei. Received: Jul. 7, 2003; Accepted: Jan. 8, 2004 Address for reprints: Dr. Ming-Huei Cheng, Department of Plastic Surgery, Chang Gung Memorial Hospital. 5, Fushing Street, Gueishan Shiang, Taoyuan, Taiwan 333, R.O.C. Tel.: 886-3-3281200 ext. 2172; Fax: 886-3-3287260; E-mail: minghueicheng@hotmail.com T he breasts are an important symbol of femininity in most cultures. A mastectomy without recon- struction causes breast deformity which affects not only physical aspects but also the psychological 275 Original Article