A comparison of factors affecting aesthetic outcomes of TRAM flap breast reconstructions.

The aesthetic results of TRAM flap breast reconstructions were assessed in 237 consecutive breast cancer patients. Nine independent judges, none of whom were plastic surgeons or members of the reconstructive team, assigned an aesthetic score to each patient after viewing postoperative photographs. We found that bilateral reconstructions were aesthetically superior to unilateral reconstructions (p = 0.0013), that immediate reconstructions were aesthetically superior to delayed reconstructions (p = 0.0001), and that previous irradiation of the chest wall reduced the mean aesthetic score (p = 0.0010). We also found that the mean aesthetic score assigned to patients who had reconstructions with free TRAM flaps was superior to that assigned to those who had reconstructions with conventional TRAM flaps, but when tested by multiple regression analysis, this trend was not statistically significant (p = 0.2972).