Helena K Puonti
Savonlinna Central Hospital, Finland
Title: Breast reconstruction with own tissue after mastectomy. A new microneurovascular technique with muscle sparing TRAM flap
Biography
Biography: Helena K Puonti
Abstract
In previous studies, it has been shown that a breast reconstruction with own tissue gives the best possible result in the long run. Furthermore, sensibility following innervated free TRAM flap for breast reconstruction improves patient-rated quality of life. In this study, we were looking for the most efficient neurorraphy technique for sensory recovery in microneurovascular muscle sparing TRAM (ms-TRAM) reconstructions after a mastectomy for breast cancer patients. All together ninety six breast cancer patients undergoing breast reconstruction by free ms-TRAM were included in the study. Both sensibility of the reconstructed breast and sensibility of abdominal skin were evaluated by neurophysiological examinations and patient questionnaire at baseline before ms-TRAM reconstruction and after 12 and 24 months postoperatively. Quantitative sensory testing (QST) was performed for tactile, vibratory and thermal sensory modalities, sharp-blunt discrimination, and spatial acuity using two-point discrimination. Results were analyzed with SPSS, and Mann-Whitney test was used. In our pilot retrospective study, twenty patients, who underwent unilateral neurorraphy, showed significantly better results when compared with the control group of twenty patients without neurorraphy. Prospective study was started in 2006. Neurorraphy technique (unilateral, bilateral or no-neurorraphy) did not compromise abdominal skin sensibility when it was compared between different groups and no major problems or pain could be detected in donor area. The sensory recovery of the reconstructed breast was significantly better in neurorraphy groups comparing with no neuro group. Our interest in the future is to investigate the results for bilateral neurorraphy.