Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap
CPT4 code
Name of the Procedure:
Breast Reconstruction with Single-Pedicled Transverse Rectus Abdominis Myocutaneous (TRAM) Flap
Summary
Breast reconstruction using a single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap involves using tissue from the patient's lower abdomen to form a new breast mound following mastectomy.
Purpose
This procedure addresses the absence of breast tissue due to mastectomy (breast removal surgery) typically performed to treat or prevent breast cancer. The goal is to reconstruct a natural-looking breast and restore the patient’s body image and symmetry.
Indications
- Individuals who have undergone mastectomy for breast cancer treatment or prevention.
- Patients seeking to restore breast shape and appearance through reconstruction.
- Suitable for patients with sufficient abdominal tissue and good overall health.
Preparation
- Patients may need to fast for a specific period before the surgery.
- Certain medications may need adjustment, including blood thinners.
- Preoperative assessments may include blood tests, imaging studies, and meeting with an anesthesiologist.
Procedure Description
- Anesthesia: The patient is given general anesthesia to ensure they are unconscious and pain-free during the surgery.
- Incisions: A horizontal incision is made in the lower abdomen to access the rectus abdominis muscle and overlying skin and fat.
- Harvesting the Flap: A section of the rectus abdominis muscle along with skin and fat is carefully detached while maintaining its blood supply (single-pedicle).
- Transfer to the Chest: The harvested tissue is tunneled under the skin to the chest area, where it is shaped into a new breast mound.
- Closure: Incisions in the abdomen and chest are closed with sutures, and drains may be placed to remove excess fluids.
- Finalization: The new breast is contoured and checked for adequate blood flow.
Duration
The procedure typically takes between 4 to 6 hours.
Setting
The surgery is performed in a hospital operating room.
Personnel
- Plastic Surgeon
- Surgical Nurses
- Anesthesiologist
- Surgical Technician
Risks and Complications
- Common risks: Bleeding, infection, and scarring.
- Rare risks: Tissue necrosis (death of the transferred tissue), hernia, abdominal weakness, or issues with the abdominal wall.
- Management includes antibiotics for infections, revisions surgery for tissue necrosis, and supportive therapies for other complications.
Benefits
- Restores breast shape and symmetry.
- Provides a more natural look and feel compared to implants.
- Long-lasting results since the tissue used is the patient’s own.
Recovery
- Hospital stay of about 3 to 5 days.
- Pain management with medications prescribed by the surgeon.
- Instructions on wound care and activity restrictions (e.g., lifting restrictions for 6 weeks).
- Full recovery and return to normal activities typically occur within 6 to 8 weeks.
- Follow-up appointments for monitoring healing and any necessary adjustments.
Alternatives
- Breast reconstruction using implants (saline or silicone).
- Other autologous tissue procedures, such as the DIEP flap.
- Pros of alternatives may include shorter recovery times (implants) or avoiding muscle damage (DIEP flap).
- Cons may include less natural feel (implants) or longer surgery durations (other flap techniques).
Patient Experience
- During the procedure, the patient is under general anesthesia and will be asleep and pain-free.
- Postoperatively, patients might experience pain and discomfort in the chest and abdomen, managed by pain medications.
- Patients should expect to manage surgical drains initially and follow specific recovery instructions to avoid complications.
- Emotional support and counseling may be beneficial as patients adjust to their new body image.