Primary closure of anterior rectus fascia after monopedicled tram harvest for breast reconstruction

Dissection of pedicled TRAM flap results in defects of both rectus muscle and anterior rectus fascia, which may cause considerable donor-site morbidity. The aim of this work is to introduce a technical modification to preserve partly anterior rectus fascia to allow its primary closure and avoid abdominal wall complications mainly hernia and abdominal bulge. Twenty two consecutive patients who underwent breast reconstruction with monopedicled TRAM flap were evaluated after primary closure of rectus fascia without mesh, regarding postoperative abdominal wall complications. Mean age of patients was 43.8y [30y-52y]. Eighteen patients underwent immediate breast reconstruction, while 4 patients underwent delayed breast reconstruction. Donor site complications was 18% and included infection, seroma and partial necrosis of the umbilicus. There was no hernia, only one patient developed abdominal bulge. Flap related complications included partial flap loss in 3 patients. There was no delay in starting adjuvant treatment in the immediate reconstruction group. It is a safe technique, which enables surgeons to dissect the flap and preserve larger area of rectus fascia to allow its primary closure without donor-site complications. We believe that this modification prevents hernia and abdominal bulge, but we need larger number of patients to better evaluate this technique

Breast conserving therapy for early breast cancer: long term follow-up

Breast conserving surgery followed by breast irradiation for appropriately selected patients with early stage breast cancer gives the same long term survival rates as radical mastectomy. The large breast volume of female Egyptian patients allows for a wide resection margin during wide local excision without a marked alteration in the aesthetic breast contour. Between 1995 and 2004, 101 female patients with early stage breast cancer were diagnosed and treated, at the Cairo National Cancer Institute hospital, by breast conserving surgery followed by postoperative radiotherapy and adjuvant systemic therapy. Patients were regulary followed up till the end of the study. Mean age of patients was 47.1 years [SD +/- 10.2]. The median time of follow-up of patients was 34 months [range: 3-127]. Kaplan-Meier estimate of 5-year local recurrence rate was 11.5% [95% confidence interval]. There was no axillary nodal recurrence. The cumulative 5 year disease tree survival was 80%. 44.5% of patients showed a good cosmetic results while 40.6% showed a fair cosmetic result. It is concluded that, inappropriately selected patients with an early stage breast cancer, they should be offered breast conserving surgery followed by breast radiation. BCT do not affect patient's survival, it preserves the breast in an acceptable cosmetic result and avoid the mutilating result of mastectomy