A Comparative Analysis Between Vertical Rectus Abdominis Myocutaneous (VRAM) Flap and Transverse Rectus Abdominis Myocutaneous (TRAM) Flap as Options for Post-mastectomy Chest Wall Reconstruction

Abstract

Background Oncoplastic breast reconstruction mitigates chest wall deformities following mastectomy or post-radiation therapy after lumpectomy. It is associated with lower morbidity, improved quality of life, and more natural aesthetic outcomes compared to traditional techniques. While free flaps yield excellent cosmetic results, their reliance on advanced microsurgical expertise poses challenges in resource-limited settings. In such contexts, pedicled flaps like the Vertical Rectus Abdominis Myocutaneous (VRAM) and Transverse Rectus Abdominis Myocutaneous (TRAM) flaps provide safe, reliable alternatives. Patients and methods This retrospective observational study analysed 45 patients who underwent post-mastectomy chest wall reconstruction at Medical College Hospital, Kolkata, between October 2020 and March 2024. Twenty-three patients received VRAM flaps (Group A), and twenty-two received TRAM flaps (Group B). The groups were compared regarding the timing of adjuvant therapy initiation, postoperative complications, donor-site morbidity, recurrence rates, and adequacy of tissue coverage. Results Adjuvant therapy was initiated in 21/23 (91.3%) of Group A (95% CI: 73.2% to 97.6%) compared to 11/22 (50.0%) of Group B (95% CI: 30.7% to 69.3%) (p=0.02). Flap necrosis occurred in 2/23 (8.7%) of Group A (95% CI: 2.4% to 26.8%) vs. 11/22 (50.0%) of Group B (95% CI: 30.7% to 69.3%) (p=0.01). Donor-site skin necrosis was absent in Group A 0/23 (0.0%) (95% CI: 0.0% to 14.3%) but occurred in 7/22 (31.8%) of Group B (95% CI: 16.4% to 52.7%) (p=0.02). Umbilical necrosis and activity limitation were only reported in Group B, each in 2/22 (9.1%) of patients (95% CI for both: 2.5% to 27.8%). Both groups achieved complete defect coverage and had no recurrences at six months. Conclusion VRAM flaps offer superior outcomes in terms of reduced postoperative complications and earlier initiation of adjuvant therapy, making them preferable in resource-constrained environments. However, longer follow-up and larger cohorts are needed to validate these findings.