Transfusion Requirements for TRAM Flap Postmastectomy Breast Reconstruction

Abstract

In Brief The transverse rectus abdominis musculocutaneous (TRAM) flap is a commonly used method for autologous tissue postmastectomy breast reconstruction. It is a major operative procedure, and some have argued that it needlessly exposes patients to increased risk of complications and blood transfusions. In this series the authors review their experience with 105 consecutive complex postmastectomy breast reconstructions, limited to double-pedicle flaps, identifying complications rates and blood transfusion requirements. Blood transfusions were required in 2.8% of patients undergoing bipedicle or bilateral TRAM flap breast reconstruction. Blood transfusions were only required in patients who experienced a complication. Obesity was associated with an increased rate of complications and blood transfusion. Routine typing and cross-matching of blood and self-donation of blood may not be required for TRAM flap breast reconstruction in low-risk patients. A review of 105 consecutive double-pedicle or bilateral TRAM flap reconstructions demonstrated only 2.8% who required blood transfusions, all of which were necessitated by a complication. The electrocautery was used extensively; the authors no longer recommend drawing preoperative autologous blood.