European Journal of Breast Health (Jul 2010)
NURSING CARE OF PATIENTS WITH RECONSTRUCTIVE BREAST SURGERY USING TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP
Abstract
Mastectomy due to breast cancer is one of the most severe traumas a woman can experience in her lifetime. Women perceive themselves as “mutilated, incomplete, diseased, and unsightly” following a mastectomy; experience emotions of depression, despair, despondency, and anger; concern for the future; and undergo adaptation problems in their relations with family members and in their sex lives. In other words, breast cancer has the devastating effect of a “living nightmare” for many women. Breast reconstruction surgery aims to reduce the nightmarish impact of breast cancer. The objective of breast reconstruction is to alleviate the woman’s feelings of being an “incomplete and crippled” person in the face of losing a sexual organ, despite the disease she has suffered. Reconstructive breast surgery can be performed simultaneously with mastectomy, or at a later stage. One intervention often preferred today is a transverse rectus abdominis myocutaneous (TRAM) flap. The primary advantages of the TRAM flap are its ability to provide a permanent, natural breast contour, removal of excess fat in the lower abdomen (tummy-tuck), and tightening of the abdominal wall. However, prolonged recovery following a TRAM flap, loss of flap, abdominal weakness, difficulty in performing daily, routine activities, and the possible need for further plastic surgery to ensure symmetry with the other breast are among the disadvantages of the TRAM flap technique. All of these factors require careful selection and care of patients who will undergo reconstruction through TRAM flap. Nursing care to be provided to patients with TRAM flaps involves flap monitoring, pain management, drain monitoring, prevention of possible complications, and home-care training of the patient.
