Pedicled transverse rectus abdominis myocutaneous flap breast reconstruction: Hospital Kuala Lumpur’s early experience

Nur A. A. Anuar, Raflis R. Awang, Ee T. Khoo, Daphne Anthonysamy, Nor A. H. Darail, Nor A. Emran


Background: Breast reconstruction is traditionally performed by the plastic surgeons. In the last four years, we have embarked on autologous breast reconstruction. We conducted a retrospective study to evaluate the complications and cosmetic outcomes of a pedicled transverse rectus abdominis myo-cutaneous (TRAM) flap breast reconstruction.

Methods: We enrolled forty-one patients who underwent a TRAM flap reconstructive surgery between January 2016 and January 2020 at the hospital Kuala Lumpur, Malaysia. Thorough retrospective reviews of medical records were performed. Patient’s satisfaction on the cosmetic outcome were assessed with the breast-Q questionnaire.

Results: Forty-one patients with a mean age of forty-six years old, had ipsilateral pedicled TRAM breast reconstructions for various breast pathologies including invasive carcinoma (n=31, 75.6%), ductal carcinoma in situ (n=8, 19.5%) and phylloides tumor (n=2, 4.9%). Immediate reconstruction was performed in thirty-nine patients and delayed reconstruction in two patients. Based on The American joint committee on cancer (AJCC) TNM system, the pathologic stages among those patients with breast cancer were 0 (n=8, 20.5%), I (n=3, 7.69%), II (n=9, 23.1%), III (n=18, 46.1%), and IV (n=1, 2.56%). During the mean follow-up of seventeen months, flap and donor site complications were reported in twelve patients (29.3%) and five patients (12.1%) respectively. Nineteen were very satisfied and sixteen were satisfied.

Conclusions: Breast reconstruction with a TRAM flap can be safely performed by the oncoplastic breast surgeons with good aesthetic outcomes.


Pedicled TRAM flap, Autologous breast reconstruction, Pos-operative complications, Cosmetic outcome

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Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg. 1982;69:216-25.

Schwitzer JA, Miller HC, Pusic AL, Matros E, Mehrara BJ, McCarthy CM, et al. Satisfaction following Unilateral Breast Reconstruction: A Comparison of Pedicled TRAM and Free Abdominal Flaps. Plast Reconstr Surg Glob Open. 2015;3(8):482.

Vania R, Pranata R, Berfan A, Budiman B. Can pedicled TRAM flap be a satisfying alternative to free TRAM in developing countries? - a systematic review and meta-analysis. Acta Chir Belg. 2020;120(6):375-82.

Azizah AM, Hashimah B, Nirmal K, Siti Zubaidah AR, Puteri NA, Nabihah A, et al. Malaysia National Cancer Registry Report (MNCR) 2012-2016. Ministry of Health Malaysia. 2016. Available at: CR_2012-2016_FINAL_(PUBLISHED_2019).pdf &usg=AOvVaw0yb6HU6h5eKO_netNtm9Az. Accessed on 24 March 2021.

Magill LJ, Robertson FP, Jell G, Mosahebi A, Keshtgar M. Determining the outcomes of post-mastectomy radiation therapy delivered to the definitive implant in patients undergoing one- and two-stage implant-based breast reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2017;70(10):1329-35.

Jones G. The pedicled TRAM flap in breast reconstruction. Clin Plast Surg. 2007;34:83-104.

Ducic I, Spear SL, Cuoco F, Hannan C. Safety and risk factors for breast reconstruction with pedicled transverse rectus abdominis musculocutaneous flaps: a 10-year analysis. Ann Plast Surg. 2005;55:559-64.

Ireton JE, Kluft JA, Ascherman JA. Unilateral and bilateral breast reconstruction with pedicled TRAM flaps: an outcomes analysis of 188 consecutive patients. Plast Reconstr Surg. 2013;1:1-7.

Kim EK, Eom JS, Sei Hyun Ahn SH, Son BH, Lee TJ. Evolution of the pedicled TRAM flap: a prospective study of 500 consecutive cases by a single surgeon in Asian patients. Ann Plast Surg. 2009;63:3:378-82.

Alderman AK, Wilkins EG, Kim HM, Lowery JC. Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2002;109:2265-74.