Microneurovascular TRAM-reconstruction of the breast

Microneurovascular TRAM-reconstruction of the breast

The transverse rectus abdominis myocutaneous flap (TRAM-flap) in the form of a free microvascular flap is the best transplant for breast reconstruction after mastectomy. It is soft and can acquirethe necessary shape. It is possible to reconstruct a round and, if necessary, large breast from it.

Since 2001, Helena Puonti has been developing amethod that allowsthe restoration of a high degree of sensation to the breasts after TRAM-reconstruction (microneurovascular technique).

Her research has shown that one nerve of the rectus abdominis myocutaneous flap sutured to a healthy nerve of the breast area can bring back normal skin sensation to abreast reconstructed with a TRAM-flap. Unless anastomosis (surgical connection) is performed between the nerve endings, sensation returns to the TRAM breast only in some cases and only to a certain extent. Radiotherapy and surgical scars may also sever the nerve in the mastectomy area.

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 doctoral thesis she is currently preparing.

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 studies 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.