Zeitschrift für Plastische Chirurgie und Kosmetologie

Breast Reconstruction: "Muscle Sparing Pedicled Tram" and "Conventional Tram" Techniques

Mohamed Ahmed Yousef Abdel-Raheem

The breast is femininity's most important external identification and breast loss can have devastating psychological effects on a woman. A woman who has lost her breast as a result of cancer may feel self-conscious, insecure, inferior to other women or unwanted by men. These body image concerns are key reasons why a woman will be motivated to pursue breast reconstruction.
The incidence of breast cancer has been increasing steadily in England for many years. Between 1977 and 2008, the age standardised incidence of invasive carcinoma of the breast rose from 75 to 124 per 100,000 women.
A woman might choose to have breast reconstruction to make her chest look balanced when she is wearing a bra or swimsuit and to permanently regain her breast shape. So she won’t have to use a breast form that fits inside the bra (an external prosthesis) then she will be happier with her body and how she feels about herself.
A breast reconstruction procedure recreates the breast mound following mastectomy and consequently restores symmetry. Reconstruction can be performed either at the same time as the initial mastectomy (immediate) or at a later date (delayed).
There are various approaches to breast reconstruction. One involves the use of an implant under the pectoralis major muscle. These procedures may involve a tissue expander (an implant into which saline may be injected to increase its size) or the insertion of a definitive fixed volume implant.
Reconstruction may also be performed using the patient’s own tissue in two distinct ways. ‘Pedicle flap’ breast reconstruction involves rotating a ‘flap’, comprised of skin, fat and usually muscle, from the patient’s back or abdomen up into the breast area, while keeping intact a tube of tissue containing its blood supply. ‘Free flap’ breast reconstruction involves a similar flap being completely detached from the patient’s body (usually from the abdomen, buttock or thigh) along with its supplying blood vessels. It is then placed at the mastectomy site, where microsurgery is undertaken to restore its blood supply by joining the vessels that supply the flap to vessels in the breast area.