Aesthetic and Clinical Outcomes with the Radiated Free TRAM Flap

Within a large fTRAM flap breast reconstruction series, experience was accumulated with patients undergoing postoperative radiotherapy to their breast reconstructions. During the study period, no patient was offered a delayed reconstruction because of planned or potential postoperative radiotherapy. Some centers now routinely delay autogenous reconstruction because of post-radiation changes to the flap. In order to add further information to this clinical dilemma, the aesthetic and psychological outcomes in the authors' series of patients were evaluated, following fTRAM flap reconstruction and postoperative radiotherapy.

A prospective evaluation of patient aesthetic, psychological, and clinical outcomes in a cohort of women with radiated fTRAMs was undertaken. Two independent plastic surgeons, uninvolved in the care or surgery to these patients, evaluated the aesthetic features of the patients' radiated fTRAMs based on a standardized evaluation form. Patients also received a standardized postoperative psychological and aesthetic satisfaction questionnaire. Kendell's tau correlation and regression analysis was applied.

Twenty-six patients with TRAM reconstruction who received postoperative radiation therapy were identified. Fourteen patients were included in this study, who completed their independent two plastic surgeon evaluation and questionnaire. Overall patient aesthetic satisfaction was 5.0 (1–6 graduated scale, 1 = poor, 6 = excellent). Overall psychological satisfaction was 3.7 (same scale). Overall physician score for aesthetics was 1.53 (0–2 graduated scale, 0 = poor, 2 = good) for physician A, and 1.50 for physician B. Patient aesthetic satisfaction was highest for shape and size (5.1, and 5.2, respectively) and least for scars – 3.8. The two physician evaluations had statistically significant concordance (68%, p = 0.01). Patient psychological satisfaction and aesthetic satisfaction were discordant (p = 0.51). Physician aesthetic evaluation and patient physical satisfaction were in agreement or concordant (tau = 0.44, p = 0.03).

In this limited study of irradiated fTRAM reconstructions, patient aesthetic satisfaction was generally very good (5.0/6). Independent plastic surgeon evaluation showed good aesthetic outcome (1.5/2). Patient psychological evaluation was less remarkable (3.7/6). Plastic surgeons and patients showed a statistically significant correlation in their aesthetic evaluation/satisfaction of the irradiated fTRAMs (p = 0.03). Both plastic surgeons showed concordance in their evaluation of the irradiated fTRAM (68%, p = 0.01). Patient aesthetic satisfaction with their irradiated TRAM reconstruction showed no correlation with their psychological satisfaction (p = 0.51).