Comparison of the aesthetic outcomes of breast reconstruction by using ipsilateral or contralateral TRAM flaps

Background: Breast reconstruction by using the rectus abdominis muscle (transverse rectus abdominis myocutaneous, TRAM) flaps is a common procedure that has been per­ formed since the 1990s. Ipsilateral TRAM flaps were proven to be as safe as contralateral flaps for breast reconstruction. However, studies comparing the aesthetic outcomes of the two procedures are poorly described in the literature. The aim of this study was to com­ pare the cosmetic outcomes of ipsilateral and contralateral pedicled flaps. Methods: We prospectively evaluated 29 cases of immediate reconstruction with ipsilateral (group 1) or contralateral (group 2) TRAM flaps. The aesthetic outcomes were analyzed and the two groups were compared. Results: The average age of the patients was 43 ± 7 years. In group 1 (ipsilateral TRAM), 91.7% of the patients presented a well-defined inframammary fold, as compared to 52.9% of the patients in group 2 (contralateral TRAM). In group 1, 8.3% of patients showed xiphoid bulges, whereas they were observed in 23.5% of patients in group 2. The difference in the overall shape of the reconstructed breast was not significant; symmetry was observed in 66.7% and 70.6% of patients in groups 1 and 2, respectively. Conclusions: Ipsilateral TRAM flaps allow better preservation of the inframammary fold and cause less xiphoid bulge. However, the overall shape of the breast and the projection of its lower pole were similar between the two groups.