Breast Reconstruction in Asians, Especially Koreans: Fascia-Sparing Free TRAM Flap

The TRAM flap has become a popular method of breast reconstruction as pedicled or free flap, and various modifications have been introduced. The ideal purpose of breast reconstruction is to create soft and aesthetically pleasing breasts. Usually, Asian oriental women with breast cancer are younger, have smaller breasts, and a thinner lower abdomen than occidental women. Sometimes, the near total area of the flap is used to create a satisfactory breast for matching with a normal breast or with an augmented normal breast. The fascia–sparing free TRAM (FSFT) flaps used by the authors incorporate as many as possible perforators and preserve most of the anterior rectus fascia, to maximize the vascularity of the flap (soft breast) and minimize donor–site morbidity.

From May 1999 to April 2005, a total of 73 free TRAM flaps were performed on 70 patients. Of the 73, 36 were immediate and 37 were delayed reconstructions. The mean patient age was 42.2 years old (23–62 years old). The average flap size was about 30x14cm. The average flap weight was about 367gm. The average Body Mass Index (BMI) was about 22.5: BMI < 20, 12 patients 20 < BMI < 22.9, 26 patients(29 flaps); 23 < BMI < 24.9, 20 patients; BMI < 25, 12 patients. They performed breast reconstructions using FSFT flaps in all patients.

Results are as follows; return to the operating room due to venous congestion in 3 flaps, moderate fat necrosis in 1 flap, mild fat necrosis at the fixation site of the flap in 5 flaps, mild lower abdominal bulging in 1 case, and no flap necrosis, loss, or abdominal hernia. Augmentation mammaplasties were done in the contralateral normal breast in 10 patients.

Preserving most of the ant. rectus fascia, while incorporating as many as possible perforators, the FSFT flap technique can increase the vascularized area of the flap and decrease complication rates at the donor site, which is ideal for breast reconstruction in a young, slender Asian woman.