Microneurovascular Free Muscle-Sparing TRAM-reconstruction of the breast

Microneurovascular Free Muscle-Sparing TRAM-reconstruction of the breast

The MS-TRAM flap (Muscle-Sparing Transverse Rectus Abdominis Myocutaneous flap) is the best transplant for breast reconstruction after mastectomy. It is soft and can acquire the necessary shape. It is possible to reconstruct a round and, if necessary, large breast from it.

Since 2001, Helena Puonti has been developing a method that allows the restoration of a high degree of sensation to the breasts after FREE MS-TRAM-reconstruction. Doctor Puonti finished her study with a dissertation in 2017 and the research included  100 patients.

Her research has shown that even one nerve of the MS-TRAM flap sutured to a healthy nerve of the breast area can bring normal skin sensation to a new breast.  With 2 nerve coaptations of the flap the sensation recovery improved even further. On average the sensitivity recovery in the whole group was 60% of a normal breast sensation. Unfortunately radiotherapy and surgical scarring may also influence on the recovery of the nerves in the mastectomy area.

The shape of the newly reconstructed breast is important for the patient's quality of life. Even more important is the fact that the breast that also feels.

Microneurovascular MS-TRAM reconstruction patients before and after the operation.

After the nerves are connected, sensation is restored to the TRAM breast to a much greater extent and, according to research, is on average equivalent to half of the normal breast sensation. However, there are cases of complete recovery in which the breast gains normal sensation.

Helena Puonti’s research is state-of-the-art globally and forms the basis for the PhD thesis she finished in 2017.

The sensation in the reconstructed breast returns gradually.  The first signs of sensation appear within about seven months after the nerves are sutured, and then skin sensation – sensitivity to cold, heat and pain – gradually starts returning.

What is important is that joining the nerves does not cause pain to the patient. On the contrary, after the use of the reconstructive microneurovascular technique there is less pain in the TRAM breast compared to traditional methods of surgery without suturing the nerve endings.

In her research Helena Puonti has found that possible pain in the breast area is generally caused by the mastectomy and/or radiotherapy used in the breast cancer treatment. Fortunately, such cases are rare.