Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients

Abstract

Introduction: The transverse myocutaneous gracilis (TMG) flap has become a popular and reliable alternative for autologous breast reconstruction. Initially described as a valuable tissue source for women with low body-mass index, indications nowadays have widely expanded. The Western civilization demographic development with its aging population and the steady growing average BMI has led to increasing breast reconstructions with TMG flaps in overweight and aged individuals. Patients and Methods: A total of 300 TMG free flaps for unilateral autologous breast reconstruction were evaluated in the form of a retrospective double center cohort study. Data extraction, study group formation and statistical analysis (One-way analysis of variance (ANOVA), Pearson’s chi-squared statistical analysis and relative risk calculation) were done specifically to evaluate age and BMI as risk factors for postoperative complications and outcome. Results: No significant differences in patients’ age and BMI in the complication groups compared to the no-complication group could be found. No significant difference regarding the occurrence of complications could be found in any of the formed risk-groups. No significant increase of minor-, major- or overall complications, flap loss or revision surgeries were found in the elderly patient groups or for patients with overweight. Conclusion: Age and overweight do not significantly increase the risk for postoperative complications after breast reconstructions with free TMG flaps. The findings of this study support the fact that microsurgical breast reconstruction with a free TMG flap should not solely be reserved for younger patients and females with a lower BMI.

Lessons Learned from 30 Years of Transverse Myocutaneous Gracilis Flap Breast Reconstruction: Historical Appraisal and Review of the Present Literature and 300 Cases

“…The exact numbers regarding the indication of secondary surgeries including lipofilling are highly variable and depend on multiple factors though such as patient satisfaction, demand, and the individual local health care provider. A recent study demonstrated that increased age and overweight are no contraindications to breast reconstructions with the TMG flap and did not cause any increase of complications [35].…”

Donor Site Morbidity in Unilateral and Bilateral Transverse Musculocutaneous Gracilis (TMG) Flap Breast Reconstruction: Sensation, Function, Aesthesis and Patient-Reported Outcomes

“…The safety and applicability of the TMG flap have been outlined in plenty of studies [5,8,16,17]. The TMG flap is based on the dominant pedicle to the gracilis muscle and its perforators nourishing the excess of fat and skin laxity harvested from the medial thigh [18].…”

“…Preoperative Doppler probe examination eases the precise localization of the dominant pedicle and may shorten the flap harvest and operation time. Recently, Schwaiger et al reported on the safe use of the TMG flap for breast reconstruction in patient populations with BMI > 25 kg/m 2 expanding its applications for breast reconstruction [17]. Moreover, Weitgasser et al conducted the first head-to-head comparison of double DIEP flaps and double TMG flaps for simultaneous breast reconstruction, emphasizing the rising value of the TMG flap for bilateral breast reconstruction [19].…”

Development of A Surgical Treatment Algorithm for Breast Reconstruction in Poland Syndrome Patients Considering Severity, Sex, and BMI

“…Since its first description by Yousif et al, the transverse myocutaneous gracilis (TMG) flap has become a commonly used free flap for breast reconstruction due to its versatility, constant and reliable anatomy and relatively simple flap harvest [ 26 ]. Although the DIEP flap remains to be the gold standard in autologous breast reconstruction for most plastic surgeons, the availability and reliability of the TMG flap in patients with a low BMI who do not offer enough tissue for an abdominal based reconstruction make the TMG flap a sound second choice for breast reconstruction in such patients [ 27 ]. Donor site morbidity of the thigh has been postulated as a drawback but has been shown to be comparable to abdominal based and other free flap options available [ 28 , 29 ].…”

“…Our study also included cases of female Poland syndrome patients who received breast reconstructions with TMG flaps. Since the TMG flap is usually considered a smaller sized flap in breast reconstruction with an average weight of 320 g, the average BMI for optimal treatment should be <25 kg/m 2 , although higher BMI is not a contraindication to utilization of the TMG flap [ 27 , 32 ]. However, in patients with a higher body weight, the DIEP flap which offers a mean average weight of 550 g is frequently a better choice for reconstruction since it offers more volume and many patients potentially benefit from the donor site in the form of an abdominoplasty [ 33 ].…”