Thoraco-abdominal flap cover for large post-mastectomy defects

The majority of breast cancer patients in India present with advanced disease, in whom radical surgical extirpation produces large defects that may not be suitable for primary closure. The primary aim in such cases is to achieve an adequate soft tissue cover expeditiously. Various methods have been tried in the past, however, there is no consensus regarding the method of choice in such situations. A retrospective analysis of the breast cancer database of a single surgical unit was done to find out an ideal surgical option in an Indian setting. Forty-five (12.8 %) out of 350 locally advanced breast cancer patients undergoing mastectomy required additional surgical procedures for soft tissue cover. Thoraco-abdominal (TA) flap was utilized for cover in 26 (7.4 %) patients. For patients undergoing TA flap repair, the mean operating time was 35 min, blood loss was 40 ml and hospital stay was 5 days. Only 1 out of 26 patients had a major wound problem, 23 patients received postoperative radiation and only 1 patient developed a local recurrence. The current study has shown encouraging results with TA flap and in view of its simplicity we recommend that TA flap should be used as a first option flap in patients with large post-mastectomy defects.

Keywords
Locally advanced breast cancer, Post-mastectomy defects, Thoraco-abdominal flap (TA flap).