Breast reconstruction has become an important part of breast cancer treatment to help restore a woman's body image and self-esteem after mastectomy. There are several options for reconstruction, including implants, flaps of tissue from the abdomen, back, or buttocks, or a combination of procedures. Immediate reconstruction at the time of mastectomy has advantages over delayed reconstruction in terms of cosmetic results and psychological impact. Proper patient selection considering health factors and goals is important to achieve a successful surgical outcome and recovery.

8. Operative Risk Factors for Breast Reconstruction With the TRAM Flap Obesity Moderate: <25% above ideal body weight Severe: >25% over ideal body weight 1 5 Small-Vessel Disease Light-to-moderate smoking (1+pack/day for 2-10 yr) Chronic heavy smoking (10-20 packs/yr) Chronic heavy smoking (20-30 packs/yr) Autoimmune disease (e.g., scleroderma, Raynaud’s) Diabetes mellitus: non insulin dependent Diabetes mellitus : insulin dependent 1 2 5 8 5 10 Psychosocial Problem Unstable emotional state (life crisis) Personality disorder Substance abuse 2 3 5

9. Operative Risk Factors for Breast Reconstruction With the TRAM Flap Contd… Abdominal Scars If” planned out” of flap design Disruption of vascular perforators: transaction of superior epigastric vessels (e.g., Chevron incision, abdominoplasty) 0.5 10 Patient’s Attitude Patient unwilling or unable to invest time require for healing or objects to abdominal scar 10 Surgeon’s Inexperience <10 TRAM flap 1 Major System Disease Process Chronic lung disease Severe cardiovascular disease 10 10

12. Delayed immediate breast reconstruction