Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Volumetric Changes Of The Pedicled Tram Flap And The Contralateral Native Breast In The Long Term Follow Up
Eun Key Kim, MD, PhD, Jin Sup Eom, MD, PhD, Taik Jong Lee, MD, PhD, Hee Jong Lee, MD, Young Chul Seo, MD, Ji Young Yun, MD, Sang Shin Lee, MD.
Asan Medical Center, Seoul, Korea, Republic of.

PURPOSE:
Outcome analysis of autologous breast reconstruction usually deals with flap survival, photographic analysis, patients’s satisfaction or quality of life, or economics. Although the effect of radiation therapy on flap volume change has been reported anecdotally, the volumetric change of the reconstructed and contralateral normal breast in the long term could not be found. We analyzed serial volumetric change of both the reconstructed and normal breast in the long term follow up, and report the trend of changes in their volumes, volume ratio, and the possible factors that might have affected them.
METHODS:
Among all patients who underwent unilateral pedicled TRAM flap immediate breast reconstruction, the patients with more than two valid postoperative PET CT data were enrolled in our study protocol. Volumes of the reconstructed and normal breast were calculated and the ratio of the flap to the contralateral breast was calculated. Serial changes in the volumes and the volume ratio were analyzed individually, and the effect of radiation therapy, endocrine therapy, and the body mass index at the time of the PET CT was also analyzed. Overall volume ratio of all the patients were described in chronological order.
RESULTS:
A total of 44 patients were included in the study. Follow up period ranged from 65 to 120 months with a median of 91. Average age at the time of reconstruction was 43.0 years and the mean BMI was 22.1 kg/cm2. Average weight of the mastectomy specimen was 412.0g, and 10(23%) and 37(84%) patients received radiation and endocrine therapy respectively.
From the first to the second period, the volume of the flap slightly increased while the volume of the breast slightly decreased. From the second to the third period, trend was to the contrary. The volume ratio first increased, and then significantly decreased. However, the amount of either volume change was within 5%.
Volume and the volume ratio changes during the follow up PET CT scnas
SequencePostoperative monthsAgeBMIFlap volumeBreast volumeFlap/Breast volume ratio
0-43.022.1
116.344.422.3431.7397.01.12
229.845.522.2435.0383.91.18
350.547.322.4428.3401.91.09



None of the variables affected the volumetric change of either the flap or the breast. Volume ratio remained relatively stable on the overall long term follow up.


CONCLUSION:
The volume of the pedicled TRAM flap first increased and then decreased slightly while the native breast showed the reverse tendency. The volume ratio changed from 1.09 to 1.18, and then eventually dropped to 1.09. Both volumes and the volume ratio remained relatively stable and there found no significant correlatable effect of radiation or endocrine therapy. However, possible conflicting effects of anti-estrogenic medication on fat and fibroglandular tissue cannot be conclusively excluded considering the fact that the number of patients who did not receive endocrine therapy was very small.


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