Radiation tolerance of transverse rectus abdominis myocutaneous-free flaps used in immediate breast reconstruction.

The authors determine the effects of postoperative radiation therapy on flap and local control outcomes in patients who have undergone immediate transverse rectus abdominis myocutaneous (TRAM)-free flap reconstruction after modified radical mastectomy for locally advanced breast cancer. Details of surgery, chemotherapy, and radiation therapy for 21 patients who had undergone immediate TRAM-free flap reconstruction after modified radical mastectomy were gathered retrospectively. The outcomes examined were flap complications, overall cosmesis, and local recurrence rate. Radiation therapy was indicated for large primary tumors (T3-T4), close or positive margins, or extensive nodal disease. With a mean follow-up interval of 19 months, there have been no flap complications or losses. Cosmesis was rated as excellent by 60% of patients, good by 30%, and fair by the remaining 10%. Three patients thought that radiation had improved cosmesis, one noted worse cosmesis, and the remainder thought it had no effect on cosmesis. The local control rate was 86%. Postreconstruction irradiation of TRAM-free flaps used in immediate reconstruction for locally advanced breast cancer appears safe and cosmetically acceptable.