Download PDF
CC BY 4.0 · Indian J Plast Surg 2025; 58(01): 070-072
DOI: 10.1055/s-0044-1791765
Case Report

Postmastectomy Late Breast Reconstruction with Transverse Rectus Abdominis Flap after Primary Closure with Latissimus Dorsi

Edmilson Micali
1   Centro de Referência da Saúde da Mulher, Hospital da Mulher, SP, Brasil
,
André Mattar
1   Centro de Referência da Saúde da Mulher, Hospital da Mulher, SP, Brasil
2   Breast Surgery Department, Oncoclínicas, SP, Brasil
,
Ana Claudia Benjamim Burattini
1   Centro de Referência da Saúde da Mulher, Hospital da Mulher, SP, Brasil
,
Luiz Henrique Gebrim
3   Breast Surgery Department, Hospital Beneficiência Portuguesa, SP, Brasil
,
René Aloisio da Costa Vieira
4   Breast Surgery Department, Hospital de Câncer de Muriaé, Muriaé, MG, Brasil
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Locally advanced breast cancer (LABC) is common in countries where organized screening is not effective. Although neoadjuvant therapy increases resectability, many patients undergo mastectomy and, in some cases, flaps are necessary for primary closure of the chest wall. Despite a worse prognosis, some of these women will achieve long-term survival and may require breast reconstruction. The literature on the subject is scarce. We present the cases of two patients with LABC undergoing neoadjuvant chemotherapy, mastectomy with extensive soft-tissue resections in the anterior chest wall, and closure with extended V-Y latissimus dorsi (LD) myocutaneous flaps. After 2 years of follow-up, they were without recurrence. They were submitted to a delayed breast reconstruction using a bipedicled transverse rectus abdominis myocutaneous (TRAM) flap. To our knowledge, this is the first publication reporting secondary reconstruction with TRAM flap after primary closure of the chest wall with LD for LABC.

Keywords

breast cancer - surgical flaps - locally advanced tumors

Authors' Contributions

E.M. performed the surgeries and wrote the manuscript. A.M. wrote the manuscript and gave support to the patients. A.C.B.B. and L.H.G. gave support to the patients. R.A.C.V. supervised and wrote the manuscript. All authors revised the last version, accepting it for publication.


Ethical Approval

This study was approved by the institutional ethics committee under the number CAAE 61439022.6.0000.0669.


Patients' Consent

The patients signed a free and informed consent form, allowing publication of the cases and associated images.




Publication History

Article published online:
24 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Micali E, Carramaschi FR. Extended V-Y latissimus dorsi musculocutaneous flap for anterior chest wall reconstruction. Plast Reconstr Surg 2001; 107 (06) 1382-1390 , discussion 1391–1392
    CrossrefPubMedSearch in Google Scholar
  • 2 da Costa Vieira RA, Andrade WP, Vieira SC, Romano M, Iglesias G, Oliveira AF. Surgical management of locally advanced breast cancer: recommendations of the Brazilian Society of Surgical Oncology. J Surg Oncol 2022; 126 (01) 57-67
    CrossrefPubMedSearch in Google Scholar
  • 3 Billington A, Dayicioglu D, Smith P, Kiluk J. Review of procedures for reconstruction of soft tissue chest wall defects following advanced breast malignancies. Cancer Control 2019; 26 (01) 1073274819827284
    CrossrefPubMedSearch in Google Scholar
  • 4 Buratini ACB, Piteri RCO, Ferreira LF. et al. Safety and viability of a new format of thoracoepigastric flap for reconstruction of the chest wall in locally advanced breast cancer: a cross-sectional study. Rev Bras Cir Plást 2016; 31 (01) 2-11
    CrossrefSearch in Google Scholar
  • 5 da Costa Vieira RA, Ching AW, de Oliveira-Junior I. Breast reconstruction for locally advanced breast cancer previously submitted to mastectomy and an ipsilateral thoracoabdominal dermofat (ITADE) flap. Breast Dis 2023; 42 (01) 229-232
    CrossrefPubMedSearch in Google Scholar
  • 6 Jalini L, Lund J, Kurup V. Nipple reconstruction using the C-V flap technique: long-term outcomes and patient satisfaction. World J Plast Surg 2017; 6 (01) 68-73
    PubMedSearch in Google Scholar
  • 7 Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 365 (9472): 1687-1717
    CrossrefPubMedSearch in Google Scholar
  • 8 Daigeler A, Simidjiiska-Belyaeva M, Drücke D. et al. The versatility of the pedicled vertical rectus abdominis myocutaneous flap in oncologic patients. Langenbecks Arch Surg 2011; 396 (08) 1271-1279
    CrossrefPubMedSearch in Google Scholar
  • 9 Wagner DS, Michelow BJ, Hartrampf Jr CR. Double-pedicle TRAM flap for unilateral breast reconstruction. Plast Reconstr Surg 1991; 88 (06) 987-997
    CrossrefPubMedSearch in Google Scholar
  • 10 Chirappapha P, Somintara O, Lertsithichai P, Kongdan Y, Supsamutchai C, Sukpanich R. Complications and oncologic outcomes of pedicled transverse rectus abdominis myocutaneous flap in breast cancer patients. Gland Surg 2016; 5 (04) 405-415
    CrossrefPubMedSearch in Google Scholar