Breast reconstruction by rectus abdominus muscle

Mastectomy is the removal of the mammary gland, a skin spindle and areola. Unfortunately, it is still necessary in some forms of breast cancer.
The flap of the rectus abdominus muscle is an original technique that can be proposed to patients with a fairly generous belly. Excess skin and fat at this level is mobilized at the chest to rebuild the breast without using a prosthesis.
The purpose of surgery is to restore the volume and contours of the breast by transferring excess skin and fat from the subumbilical abdominal area to the chest. The technique gives the reconstructed breast a relatively natural shape and flexibility since it is made of the patient's own tissues.
It is only one of the steps of complete breast reconstruction, which also includes, according to the patient's wishes, reconstruction of the areola and nipple and possibly an intervention on the contralateral breast to improve symmetry.

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This is a delicate procedure that can cause significant blood loss and requires the patient to be in good general condition.
A regular preoperative check-up is carried out in accordance with the instructions. An auto-transfusion may be offered (collection and storage of your own blood a few weeks before the procedure) to limit transfusion risks. The anaesthetist will then be seen in consultation at least one month before the operation and at the latest 48 hours before the operation in other cases.
In all cases, the practitioner should check the breast imaging (mammography, ultrasound) of the other breast if the last control examination is not recent enough.
No medication containing aspirin should be taken within 10 days of the procedure.
The thromboembolic risks of this type of reconstruction are quite high and it is possible that the anaesthetist prescribes antithrombosis stockings (prevention of phlebitis) that you will have to wear even before the operation until you leave the institution. You are also asked to buy an abdominal support girdle that staples to the front to provide support from the first bandage. It will then be worn continuously for several weeks.
Type of anesthesia:
This is a classic general anaesthesia during which you will sleep completely.
Hospitalization conditions:
A hospitalization of 4 to 8 days is usually necessary. The discharge will be conditioned by the success of the intervention and the removal of the drainage.

The procedure is usually performed at a distance from the mastectomy and the additional treatments that were necessary, referred to as secondary reconstruction.
The mastectomy scar is reused as an approach in reconstruction; while it can sometimes be improved, it is impossible to remove it.
The intervention is intended for women who are rather large, not very athletic and non-smoking.
The procedure consists of transferring a horizontal spindle of skin and fat from the subumbilical abdominal region to the thorax and keeping it alive using the rectus abdominus muscle.
This flap is slid under the supra-umbilical skin and inserted between the mastectomy scar and the submammary sulcus as an insert.
Closing the donor site results in a lower scar across the entire width of the abdomen.
The volume provided is such that the surgeon does not need to use any internal prosthesis and the improvement of the silhouette in the abdomen is often perceived as a pleasure. On the other hand, the reconstructed breast will have little sensitivity to touch since all nerve cells of the sensitivity were interrupted during the transfer.
A synthetic reinforcement is put in place to strengthen the abdominal wall weakened by the loss of part of the rectus muscle.
Symmetrization of the other breast and reconstruction of the nipple-areolar plate (areola + nipple) are most often performed later when the volume of the reconstructed breast is stabilized.
The reconstruction by a flap of the rectus abdominus muscle (TRAM) immediately restores a volume and shape that allows the patient to dress normally with a neckline.

However, the final result is not immediately established. At first, the breast may appear a little too stiff with a feeling of tightness in the stomach.
The appearance of the reconstructed breast will gradually change. It takes two to three months for your surgeon to appreciate the result and in particular the symmetry.
It is only at this stage that a possible retouching is contemplated.
l’intégration psychique de ce volume insensible peut être difficile et une période d’ambivalence d’au moins six mois est souvent constatée. L’entourage médical et familial joue un rôle important dans cette période durant laquelle la patiente a besoin d’être rassurée.

About Breast reconstruction by rectus abdominus muscle

Breast reconstruction by a flap of the rectus abdomens muscle is a fairly heavy surgical procedure, which implies the risks associated with any such procedure.
However, the postoperative consequences are generally quite simple. Nevertheless, complications can occur, some of a general nature, inherent in any surgical procedure, others more specific to breast reconstruction by TRAM.
Complications, however, must be known and well understood. This is how it can be observed: skin necrosis, infection, hematoma, serous effusion, etc.
By choosing a qualified and competent surgeon, trained in this type of procedure, you minimize these risks, but do not eliminate them completely.
MEDICAIM organizes your entire stay for you: post-operative nursing care, biological follow-up, therapeutic, nutritional and psychological support.
Any additional questions? Ask your MEDICAIM doctor about it: careteam@medicaim.com