Skin-preserving radical mastectomy with simultaneous breast reconstruction with a free ms-tram flap on microsurgical anastomoses

   Introduction. Together with the development of the methods for surgical removal of the breast the methods of its restoration have been improving as well. It should be considered that the purpose of a breast reconstruction is to recreate a natural, plastic form and maximum symmetry, so the surgical treatment is chosen individually, taking into account the patient's anamnesis and anatomical features. These tasks allow solving various methods of autologous reconstruction, where flaps of the anterior abdominal wall (both in a single-stage and in a delayed version) are gold standards today. The question of the degree of injury to the donor zone is one of the important links while choosing a flap harvesting option.
   Discussion. The article presents a clinical case and describes in detail the simultaneous reconstruction with a free MS-TRAM flap (Muscle-Sparing Transverse Rectus Abdominis Myocutaneous flap) – a muscle-sparing variant of flap lifting, which is a good alternative to the DIEP flap in case of technical difficulties, coming from the topographic and anatomical features of vessels and occurring during a surgery.
   Conclusions. This technique reduces the likelihood of postoperative complications at the donor zone and, in some cases, may exclude the use of a mesh implant. There is no substantial difference in performing the "sit-up" test during the postoperative period in the case of transplantation of DIEP and MS-TRAM flaps.

1. Telichko S. V., Kovalenko N. V., Zhavoronkova V. V., Ivanov A. I., Sukhov V. A., Speransky D. L., Devyatchenko T. F., Chukhnin A. G. Modern methods of breast reconstruction. Own experience. Journal of VolgSMU, 2020, № 3 (75), pp.179–184. (In Russ.)

2. Shapovalov S. G., Kcheuso A. V. Optimization of reconstructive plastic surgery in women after mastectomy. Scientific and practical conference with international participation dedicated to the 75th anniversary of the first burn center in Russia and the 85th anniversary of Professor K. M. Krylov. Theses. Emergency Surgery named after I. I.Janelidze, 2021, pp. 71–72. (In Russ.)

3. Ozhorbayev M. T., Budlyansky A. V., Elishev V. G. Breast plastic surgery options for organ-preserving breast cancer surgery. Ural Medical Journal, 2020, № 2 (185), pp. 9–10. (In Russ.)

4. Zikiryakhodzhaev A. D., Volchenko A. A., Ermoshenkova M. V., Sukhotko A. S. Algorithm for choosing reconstructive plastic surgery in patients with breast cancer. Volga Oncological Bulletin, 2015, № 3, pp. 38–44. (In Russ.)

5. Startseva O. I., Melnikov D. V., Sinelnikov M. E., Ivanov S. I., Makarenko D. A. Breast reconstruction with a free DIEP flap in a patient with Lyell’s syndrome. Analysis of clinical experience. Annals of Plastic, Reconstructive and Aesthetic Surgery, 2018, № 3, pp. 41–47. (In Russ.)

6. Kroll S. S., Ames F., Singletary S. E. et al. The oncologic risks of skin preservation at mastectomy when combined with immediate reconstruction of the breast. Surg. Gyn. Obstetrics., 2011, № 172, рр. 17.

7. Petit J. Y., Veronesi U., Luini A. et al. Nipple sparing mastectomy in association with intraoperative radiotherapy (ELIOT): a new type of mastectomy for breast cancer. Breast Cancer Res. Treat., 2006, № 96, рр. 47–51.

8. Volchenko A. A., Chissov V. I., Zikiryakhodzhaev A. D. The choice of reconstructive plastic surgery in the complex treatment of breast cancer patients. Oncology. P. A. Herzen Journal, 2014, № 1, pp. 3–9

9. Chizhikov A. V., Grigoriev P. A., Shchukin V. Yu., Teplyakova A. A., Belaya Yu. A., Kanabaev A. V., Siverskaya Ya. V. Results of breast reconstruction with tram flap. Ugra Healthcare: Experience and Innovations, 2016, № С, pp. 40–42.

10. Duadze I. S., Zikiryakhodjaev A. D., Sukhotko A. S., Starkova M. V., Usov F. N., Bagdasarova D. V., Dzhabrailova D. Sh., Khakimova Sh. G. Breast reconstruction using a flap on the perforant of the deep inferior epigastric artery (diep-flap). History of development. Research and practice in Medicine, 2021, V. 8, № 3, pp. 108–117

11. Galich S. P., Smolanka I. I. (senior), Dabizha A. Yu., Samko K. A., Kostenko A. A., Simulik E. V., Borovik D. V., Greben N. I., Ternitskaya Yu. P., Smolanka I. I. (junior). Breast reconstruction using a free tram flap transplant in various modifications for breast cancer: analysis of results and complications. Clinical Oncology, 2017, № 4 (28), pp. 42–47.

12. American Society of Plastic Surgeons. Plastic surgery statistics report 2015. Available at: https://www.plasticsurgery.org/news/plastic-surgery-statistics?sub=2015+Plastic+Surgery+Statistics. Accessed November 1, 2016.

13. Yarema V. I., Stepanyants N. G., Ronzin A. V., Magomedov M. R., Safronova V. V., Neznamov A. N. Results of reconstructive operations for breast tumors. Collection of abstracts of the 7th International Scientific and Practical Conference on clinical lymphology “LYMPH-2019”, 2019, pp. 38–39.

14. Yarema V. I., Fatuev O. E., Stepanyants N. G., Safronova V. V. Immediate and long-term results of surgical interventions on the mammary gland. Research and Practice in Medicine, 2019, № 6 (2), pp. 110–119.