Preservation of Deep-Layer Fat of Lateral Zones Prevents Postoperative Seroma after TRAM-flap Harvesting for Breast Reconstruction: a Retrospective Study

Objective: The present study elucidates whether or not preserving fat tissues deeper than the Scarpa's fascia in zone 3 and zone 4 reduces postoperative fluid collection after harvesting the transverse rectus-abdominis muscle (TRAM) flap. Methods: Thirty-one patients for whom breast reconstruction with free TRAM flaps had been performed were included in the study. Fat tissues deeper than the Scarpa's fascia in zone 3 and zone 4 were addressed in two ways. With 17 patients, these tissues were preserved on the abdominal wall; with 14 patients, these fat tissues were harvested as part of the TRAM flap. The former and latter groups were named the Preservation Group and Non-Preservation Group, respectively. Drainage tubes were placed at the donor site until daily drainage became less than 20 ml, at which time the tubes were removed. The total amount of postoperative fluid drained from the donor site and the days required before tube removal were compared between the two groups. Results: The total volume of drained fluid was significantly greater for the Non-Preservation Group (444 +/- 48.2 ml) than for the Preservation Group (230 +/- 21.9 ml); the period before removal of drainage tubes was significantly longer for the Non-Preservation Group (12.4 +/- 0.84 days) than for the Preservation Group (7.6 +/- 0.55 days). Conclusion: Preservation of deep-fat tissues in zone 3 and zone 4 reduces postoperative fluid exuded from the donor site, and enables earlier removal of drainage tubes. For cases where optimal breast shape can be achieved without these fat tissues, the fat tissues should be preserved.