Purpose: Controversy exists regarding the safety of radiating Transverse Rectus Abdominis Myocutaneous (TRAM) flaps done after mastectomy. This retrospective study directly compares outcomes for radiated TRAMs to a cohort of non-radiated TRAMs post-mastectomy.

Methods: From January 1996, through September 2005, 352 patients underwent immediate TRAM flap post-mastectomy. Forty-five of those patients received adjuvant radiotherapy. Age range was 29-72 (mean 49.5 years). Follow-up was 1-9 years (mean 48 months). Fifty patients who underwent immediate TRAM flap post-mastectomy without adjuvant radiotherapy served as a control group.

Results: Flap survival was 100% in both groups. In the radiated group, median operative time was 5.5 hours. Average hospital stay was 5.2 days. Fat necrosis occurred in 3 patients (7%) with 2 (4%) requiring additional surgery for volume loss. Local recurrence was seen in 1 patient (2%) and distant metastases in 4 patients (9%). Average total radiation was 5586 cGy and was not directed to internal mammary nodes. There were no significant differences in outcomes for the radiated and control groups.

Conclusions: Adjuvant Radiotherapy after TRAM flap reconstruction post-mastectomy is safe and comparable in outcome to non-radiated patients. This is contrary to some published literature and is likely explained by differential methods of radiotherapy administration.