Amarachi came to us in September , 2015. She had been treated at another hospital and now had recurrent breast cancer on the right chest that extended almost to the axilla and was fixed to the chest wall. She also had breast cancer in the left breast. Despite the situation, she had a very good functional status.
We decided to proceed with excision of the recurrence. Unfortunately, resection left a much bigger wound than I had initially expected. This was a significant problem because we wanted her to get healed as fast as possible so we could initiate chemotherapy.
While looking at the gaping hole we had produced, it occurred to me that we could do a TRAM Flap (transverse rectus abdominis flap). The TRAM, consists of the skin, fat, and muscle of the lower abdomen with its blood supply, which is tunneled beneath the skin to the chest. This would be a perfect way to cover the wound with healthy tissue. The only problem was that I had never done this procedure before. After a few minutes of reading, we proceeded.
The flap was raised using the skin between the umbilicus and the pubic bone, keeping it attached to the rectus muscle. We then tunneled the skin to the chest and the skin paddle perfectly fit our surgical defect. We then closed all the wounds and Amarachi healed great. She had a nice tummy tuck as well.
In January, 2016, I returned to find her doing very well. She had actually added some weight and was healed. We then proceeded with a modified radical mastectomy on the left side.
When I saw her in April she was already back on chemotherapy . Her weight was stable and she had no signs of metastatic disease. Of course, statistics are not in her favor but she is living a healthy life and I expect she will be around for some time to come. She may dies from this cancer but she will avoid a fungating cancer on her chest . Most importantly, she is happy with the results.