BACKGROUND: The potential for donor-site morbidity associated with bilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction has led to the popularization of deep inferior epigastric artery perforator (DIEP) flap reconstruction. This study compares postoperative morbidity and satisfaction following bilateral pedicled TRAM and DIEP flap reconstruction. METHODS: One hundred five women with bilateral pedicled TRAM flaps were compared with 58 women with bilateral DIEP flap reconstruction. Medical records were reviewed for complications and demographic data. Postoperative follow-up data were obtained through Short Form-36, Functional Assessment of Cancer Therapy-Breast, Michigan Breast Satisfaction, and Qualitative Assessment of Back Pain surveys. RESULTS: The mean follow-up interval was 6.2 years in the bilateral TRAM group and 2.3 years in the bilateral DIEP group (p < 0.001). Demographic data were otherwise similar. Abdominal hernias occurred in three TRAM patients (2.9 percent) and in no DIEP patients, whereas abdominal bulges occurred in three TRAM patients (2.9 percent) and four DIEP patients (6.9 percent); these differences were not statistically significant. Fat necrosis occurred less frequently in the TRAM group (p = 0.04). Postoperative survey results revealed no significant difference in patient satisfaction, incidence of back pain, or physical function. The TRAM group scored higher in the Medical Outcome Study Short Form-36 subjective energy category (p = 0.01) and mean Functional Assessment of Cancer Therapy-Breast score (p = 0.01). CONCLUSIONS: This study suggests no significant differences in donor-site morbidity, survey-based functional outcome, or patient satisfaction between bilateral TRAM and DIEP flap breast reconstruction. Although perforator flaps represent an important technological advancement, bilateral pedicled TRAM flap reconstruction still represents a good option for autologous breast reconstruction.
BACKGROUND: The potential for donor-site morbidity associated with bilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction has led to the popularization of deep inferior epigastric artery perforator (DIEP) flap reconstruction. This study compares postoperative morbidity and satisfaction following bilateral pedicled TRAM and DIEP flap reconstruction. METHODS: One hundred five women with bilateral pedicled TRAM flaps were compared with 58 women with bilateral DIEP flap reconstruction. Medical records were reviewed for complications and demographic data. Postoperative follow-up data were obtained through Short Form-36, Functional Assessment of Cancer Therapy-Breast, Michigan Breast Satisfaction, and Qualitative Assessment of Back Pain surveys. RESULTS: The mean follow-up interval was 6.2 years in the bilateral TRAM group and 2.3 years in the bilateral DIEP group (p < 0.001). Demographic data were otherwise similar. Abdominal hernias occurred in three TRAM patients (2.9 percent) and in no DIEPpatients, whereas abdominal bulges occurred in three TRAM patients (2.9 percent) and four DIEPpatients (6.9 percent); these differences were not statistically significant. Fat necrosis occurred less frequently in the TRAM group (p = 0.04). Postoperative survey results revealed no significant difference in patient satisfaction, incidence of back pain, or physical function. The TRAM group scored higher in the Medical Outcome Study Short Form-36 subjective energy category (p = 0.01) and mean Functional Assessment of Cancer Therapy-Breast score (p = 0.01). CONCLUSIONS: This study suggests no significant differences in donor-site morbidity, survey-based functional outcome, or patient satisfaction between bilateral TRAM and DIEP flap breast reconstruction. Although perforator flaps represent an important technological advancement, bilateral pedicled TRAM flap reconstruction still represents a good option for autologous breast reconstruction.
Authors: Sheina A Macadam; Toni Zhong; Katie Weichman; Michael Papsdorf; Peter A Lennox; Alexes Hazen; Evan Matros; Joseph Disa; Babak Mehrara; Andrea L Pusic Journal: Plast Reconstr Surg Date: 2016-03 Impact factor: 4.730
Authors: Katelyn G Bennett; Ji Qi; Hyungjin M Kim; Jennifer B Hamill; Andrea L Pusic; Edwin G Wilkins Journal: JAMA Surg Date: 2018-10-01 Impact factor: 14.766
Authors: Edwin G Wilkins; Jennifer B Hamill; Hyungjin M Kim; John Y Kim; Richard J Greco; Ji Qi; Andrea L Pusic Journal: Ann Surg Date: 2018-01 Impact factor: 12.969
Authors: Andri Thorarinsson; Victoria Fröjd; Lars Kölby; Johan Ljungdal; Charles Taft; Hans Mark Journal: Plast Reconstr Surg Glob Open Date: 2017-06-21
Authors: Christoph Andree; Stefan Langer; Katrin Seidenstuecker; Philipp Richrath; Philipp Behrendt; Tobias Koeppe; Mazen Hagouan; Christan Witzel; Samma Al Benna; Beatrix Munder Journal: Med Sci Monit Date: 2013-06-17