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Autologous breast reconstruction
Astrauskas T., Urbonas T., Astrauskaite G., Kaunas Medical University Clinics 
The purpose of this study was to compare 3 different techniques of autologous breast reconstruction in their indications to calculate their complication rates and to design a simple algorithm for breast reconstruction based on indications. 
Women after mastectomy or breast-conservative surgery or those who had congenital breast defects and who underwent breast reconstruction with thoracodorsal (TD) or transverse rectus abdominis myocutaneous TRAM flaps or had autologous fat injections (AFI) in Kaunas Medical University Clinics and Kaunas Oncology Hospital from the year 2000 to the year 2008 were included in the study. The indications or criteria on which the surgeons decided to choose one of the 3 procedures were determined. The postoperative outcomes were evaluated and analysed statistically.
Data were collected on 168 women who had one of the procedures: 104 TRAM flap reconstructions; 64 TD flap reconstructions; 25 AFI. The indications for TRAM flap reconstruction were mastectomy and the fail of an alternate method of breast reconstruction. The indications for TD flap reconstruction were breast volume-decreasing surgery smaller in it’s extent than mastectomy, certain abdominal wall scars that impede for TRAM flap reconstruction and Poland syndrome. The indication for AFI was breast contours correction after breast reconstruction.
There were 14,3% partial flap necroses, 11,2% donor site dehiscence and 6,1% of abdominal wall laxity in TRAM flap group. There were 1,6% partial flap necroses and 57,8% seromas in TD flap group. There were a fat resorbtion of 40-60% of injected volume in all AFI patients and 16% of the patients required an additional session of AFI.
The TRAM flap reconstruction should be made for the patients who have undergone mastectomy or for those who refused to have scars in the back. The TD flap reconstruction is preferable after breast-conservative surgery or for the patients with Poland syndrome. The AFI is a cosmetic procedure that supplements breast reconstruction and could be used for contours correction.

Tautrimas Aštrauskas - Certified Plastic & Reconstructive Surgeon www.blossomandjasmine.com solution: inverse.lt