Since 1998, there are more patients receiving radiation after mastectomy and, therefore, after breast reconstruction. There are no reports of a large series of patients who were personally examined at least two years after radiation of a TRAM flap performed by a single surgeon. This paper will represent a series of 43 patients who received radiation treatment after immediate TRAM flap breast reconstruction. They were examined utilizing a newly developed grading system. This was used to personally examine the patients no less than two years after reconstruction by two non-involved plastic surgeons. Both pedicle TRAM flaps and free TRAM flaps were used. Three patients were lost to followup. Of the 40 patients, 8 had TRAM flap complications or complications of the chest wall skin, which made the isolated effect of the postoperative radiation difficult to judge. Of the patients who did not have complications of TRAM reconstruction, 60% were unaffected by the postoperative radiation. A higher dose of radiation was not found to be related to increased chance of having a deleterious affect on the TRAM.

Conclusion: This is the largest series of patients who had radiation after immediate TRAM reconstruction by a single surgeon. Each patient was examined no less than two years postoperatively by two uninvolved plastic surgeons. Only 60% of the TRAM flaps were found to be unaffected by the postoperative radiation, with good to excellent cosmetic results. Of the remaining 40%, many required further operative procedures to achieve satisfactory results. This percent of deterioration of the TRAM result is higher than previously reported, probably secondary to this long followup and critical examination by independent plastic surgeons.