Comparison of Morbidity, Functional Outcome, and Satisfaction following Bilateral TRAM versus Bilateral DIEP Flap Breast Reconstruction

Chun, Yoon S.; Sinha, Indranil; Turko, Arthur; Yueh, Janet H.; Lipsitz, Stuart; Pribaz, Julian J.; Lee, Bernard T.

doi:10.1097/prs.0b013e3181ea42d3

Cited by 79 publications

(40 citation statements)

References 31 publications

(33 reference statements)

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“…14 Furthermore, muscle-sparing procedures are often associated with longer operative times and require specialized surgeon training. Longer operative times may impart greater peri-operative risk to patients and are associated with increased health care costs.…”

Section: Introductionmentioning

confidence: 99%

Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors

Macadam

Zhong²,

Weichman

et al. 2016

Plastic and Reconstructive Surgery

114

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Background Approximately 20% of women select autologous tissue for postmastectomy breast reconstruction, and most commonly choose the abdomen as the donor site. An increasing proportion of women are seeking muscle-sparing procedures but the benefit remains controversial. It is therefore important to determine whether better outcomes are associated with these techniques, thereby justifying longer operative times and increased costs. Methods Patients from five North American centers were eligible if they had reconstruction using the deep inferior epigastric artery perforator flap (DIEP), muscle sparing free transverse abdominis myocutaneous flap (msf-TRAM), free transverse abdominis myocutaneous flap (f-TRAM), or the pedicled transverse abdominis myocutaneous flap (p-TRAM) with minimum one-year follow-up. Patients were sent the BREAST-Q©. Demographics and complications were collected by chart review. Results We analyzed 1790 charts representing 670 DIEP, 293 msf-TRAM, 683 p-TRAM, and 144 f-TRAM patients with average follow up of 5.5 years. Flap loss did not differ by flap type. Partial flap loss was higher in p-TRAM compared to DIEP (p=0.002). Fat necrosis was higher in p-TRAM compared to DIEP and msf-TRAM (p<0.001). Hernia/bulge was highest in p-TRAM (p<0.001). Physical Well-Being (Abdomen) scores were higher in DIEP compared to p-TRAM controlling for age, follow-up, BMI, laterality, abdominal surgery, mesh, radiation, income, and education. Conclusions Complications and patient-reported outcomes differ when comparing abdominally-based breast reconstruction techniques. The results of this study show that the DIEP was associated with the highest abdominal well-being and the lowest abdominal morbidity when compared to the p-TRAM, but did not differ from msf-TRAM and f-TRAM.

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Section: Introductionmentioning

confidence: 99%

Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors

Macadam

Zhong²,

Weichman

et al. 2016

Plastic and Reconstructive Surgery

114

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“…Moreover, abdominal hernias occur more frequently in patients receiving a TRAM flap (16%) than a DIEP flap (1%). Together, these considerations account for the preference for and further refinement of DIEP rather than TRAM reconstructions [18,19].…”

Section: Autologous Flaps General Considerationsmentioning

confidence: 94%

Magnetic Resonance Imaging of Breast Implants and the Reconstructed Breast

Thomassin‐Naggara

Atlan

Chopier

et al. 2015

Diseases of the Chest and Heart 2015–2018

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“…Reported rates of bulge are 1.7 to 4% and hernia are 0.85 to 2.9%. [4][5][6][7] Surgical-site morbidity may be as high as 8.5 to 14.3%. 4,7 A minimally invasive approach precludes violation of the anterior rectus sheath from costal margin to pubis, which may reduce the risk of surgical donor-site morbidity.…”

mentioning

confidence: 99%

Robotic Harvest of the Rectus Abdominis Muscle: A Preclinical Investigation and Case Report

Patel

Pedersen

2011

J reconstr Microsurg

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In an attempt to decrease donor-site morbidity for rectus abdominis muscle harvest during free tissue transfer, we developed a technique of minimally invasive harvest. The da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) was used in two cadavers for dissection and harvest of four rectus abdominis muscles. After the cadaver dissections were performed, the technique was used in a 30-year-old woman to harvest the left rectus abdominis muscle for free tissue transfer to a lower extremity defect. Four cadaver dissections for harvest of the rectus abdominis muscle using the da Vinci Surgical System were performed. In the cadavers and actual case, three ports (11 mm, 11 mm, and 15 mm) were used to access the abdominal cavity and perform the dissection. An additional 3 cm incision was used to remove the muscle from the abdominal cavity. The patient has not developed any surgical-site morbidity, including bulge or hernia in the 6 months postprocedure. Minimally invasive harvest of the rectus abdominis muscle is possible with the assistance of the da Vinci Surgical System. Potential benefits may include decreased surgical-site morbidity. Also, this may provide an approach to minimally invasive transperitoneal reconstruction.

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Comparison of Morbidity, Functional Outcome, and Satisfaction following Bilateral TRAM versus Bilateral DIEP Flap Breast Reconstruction

Cited by 79 publications

References 31 publications

Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors

Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors

Magnetic Resonance Imaging of Breast Implants and the Reconstructed Breast

Robotic Harvest of the Rectus Abdominis Muscle: A Preclinical Investigation and Case Report

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