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Complica es em reconstru o de mama com retalho pediculado do músculo reto abdominal transverso Complications in breast reconstruction using a transverse rectus abdominis myocutaneous flap

Keywords: Mama , Mamoplastia , Procedimentos cirúrgicos reconstrutivos , Retalhos cirúrgicos , Músculos abdominais , Breast , Mammaplasty , Reconstructive surgical procedures , Surgical flaps , Abdominal muscles

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Abstract:

INTRODU O: O cancer de mama é a afec o que mais causa mortes na popula o feminina. Seu tratamento é principalmente cirúrgico, o que causa grande impacto psicossocial na mulher. Para diminuir esse abalo, a cirurgia reconstrutiva oferece diferentes op es, como o retalho do músculo reto abdominal transverso (TRAM). Essa é uma alternativa de reconstru o que tem sido bastante utilizada nos últimos 30 anos, mundialmente. Embora seja a mais aplicada e a técnica que possibilita melhores resultados estéticos e funcionais, n o deixa de apresentar complica es. O objetivo deste estudo é apresentar as principais complica es do TRAM de acordo com suas variantes (ipsilateral, contralateral e bilateral) e com o tempo da reconstru o. MéTODO: Foram avaliadas 30 pacientes submetidas a mastectomia e reconstru o mamária com TRAM pediculado, sendo 25 reconstru es imediatas e 5 tardias. Foram analisadas as complica es das áreas doadora e receptora. RESULTADOS: Dentre as complica es identificadas, a necrose gordurosa na mama foi a mais incidente, mas também foram verificados casos de infec o, seroma, hérnia abdominal, sofrimento da pele em áreas doadora e receptora, e trombose venosa profunda. As complica es foram mais frequentes nas pacientes que realizaram o TRAM bilateral tardiamente. CONCLUS ES: Assim como todos os tipos de cirurgia, a reconstru o de mama pelo TRAM, mesmo passados 30 anos desde sua descri o, está sujeita a diversas complica es no pós-operatório. BACKGROUND: Breast cancer is the leading cause of death in the female population. The treatment for breast cancer is primarily surgical, which has a great psychosocial impact on women. To reduce this trauma, reconstructive surgery offers different options including the use of a retail transverse rectus abdominis (TRAM) flap. This is an alternative reconstruction that has been widely used worldwide over the last 30 years. Although reconstruction using the TRAM flap is the most widely used technique that yields the best aesthetic and functional results, it is associated with certain complications. The aim of this study is to present the main complications of reconstruction using the TRAM flap according to its variants (ipsilateral, contralateral, and bilateral) and reconstruction time. METHODS: We evaluated 30 patients who had a mastectomy and breast reconstruction using the TRAM flap, including 25 immediate reconstructions and 5 late reconstructions, and analyzed the complications of the donor and recipient areas. RESULTS: Among the identified complications, fat necrosis in the breast was the most f

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