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Breast Reconstruction with a Transverse Rectus Abdominis Myocutaneous Flap: Spectrum of Normal and Abnormal MR Imaging Findings¹

¹ From the Departments of Radiology (R.K.D., M.A.R., S.G.O.) and Pathology (C.M.), Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104. Received November 28, 2003; revision requested February 6, 2004, and received March 23; accepted March 25. All authors have no financial relationships to disclose. Address correspondence to M.A.R. (e-mail: rosen@oasis.rad.upenn.edu).

The authors retrospectively reviewed their clinical database for cases of breast magnetic resonance (MR) imaging performed in women who had undergone breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap. Patient histories, MR imaging results, and, when available, biopsy results were reviewed. During a 4-year period, 24 neobreasts were imaged in 22 women who had undergone TRAM flap reconstruction after mastectomy. In most of the cases (64%), the indication for MR imaging was a palpable abnormality or pain. In four of 24 cases (17%), recurrent breast cancer was detected. These cases consisted of a local chest wall tumor (n = 2), an infiltrating chest wall tumor (n = 1), and axillary nodal recurrence (n = 1). In all four cases, MR imaging demonstrated a suspicious lesion or abnormality. In 11 of 24 cases (46%), benign findings only were demonstrated. These consisted of localized or diffuse skin thickening, fibrosis, fat necrosis, and seroma. In nine of 24 cases (38%), no pathologic abnormality was identified. MR imaging is useful in detection of locally recurrent tumor in patients who have undergone breast reconstruction with a TRAM flap. MR imaging allows differentiation between benign and malignant findings in patients with palpable abnormalities or pain after TRAM flap reconstruction.

© RSNA, 2004

Index Terms: Breast, surgery, 00.4545 • Grafts, 00.4545

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