Outcomes and Patient Satisfaction following Breast Reconstruction with Bilateral Pedicled TRAM Flaps in 105 Consecutive Patients

Chun, Yoon S.; Sinha, Indranil; Turko, Arthur; Lipsitz, Stuart R.; Pribaz, Julian J.

doi:10.1097/prs.0b013e3181c2a620

Cited by 49 publications

(33 citation statements)

References 24 publications

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“…Although previous research has examined psychosocial outcomes among women who undergo mastectomy with and without reconstruction and breast-conservation therapy, many studies have used cross-sectional study designs, which lack baseline data for comparison and a longitudinal perspective. [4][5][6][7][8][9][10][11][12][13] samples of patients who underwent a variety of different postmastectomy breast reconstruction techniques whose outcomes evolved with various timelines.…”

Section: Introductionmentioning

confidence: 99%

Patient satisfaction and health‐related quality of life after autologous tissue breast reconstruction

Zhong

McCarthy

Min

et al. 2011

Cancer

173

100

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were asked to complete the BREAST-Q, Hospital Anxiety and Depression Scale (HADS), and Impact of Event Scale (IES) questionnaires before surgery and at 3 weeks and 3 months after surgery. A repeated-measures design was used to compare scores between baseline and postoperative time points. RESULTS: Fifty-one of 55 women completed the questionnaires (response rate, 93%). BREAST-Q subscale scores (breast, sexual well being, and psychosocial well being) improved significantly (P < .05) postoperatively. The other subscale scores related to physical well being of the chest and abdomen dropped significantly 3 weeks after reconstruction; and, by 3 months after reconstruction, both scores improved significantly (P < .05). Large effect sizes for improvements in satisfaction, psychosocial well being, and sexual well being were observed (1.88, 1.2, and 1.31, respectively); whereas deterioration in the effect size for abdominal donor site was reported (À1.56). After adjusting for postoperative complications, there were statistically significant changes in BREAST-Q subscale scores. Changes observed on the HADS and IES provided external validation of the findings obtained on the BREAST-Q. CONCLUSIONS: The current results suggested that the gains in breast satisfaction, psychosocial well being, and sexual well being after patients undergo either free muscle-sparing transverse rectus abdominis myocutaneous flap reconstruction or deep inferior epigastric artery flap reconstruction are statistically significant and clinically meaningful to the patient as early as 3 weeks after surgery. However, these gains are accompanied by significant deterioration in physical well being of the abdominal donor site. Cancer 2012;118:1701-

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Section: Introductionmentioning

confidence: 99%

Patient satisfaction and health‐related quality of life after autologous tissue breast reconstruction

Zhong

McCarthy

Min

et al. 2011

Cancer

173

100

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“…Abdominal morbidity is considered the greatest problem from the pedicled TRAM flap (16). This concern is exacerbated following a bipedicled TRAM flap breast reconstruction where both rectus abdominis muscles are harvested (4). The limitation of the current study is that the functional results were not evaluated.…”

Section: Discussionmentioning

confidence: 91%

“…In the series of 105 bilateral pedicled TRAM flaps of Yoon et al, there was 2.9% hernia and 2.9% abdominal bulging. It is worth noting that the authors made use of polypropylene mesh for donor site closing (4). In a large clinical series of 103 patients, which employed a mesh for bipedicled TRAM flap donor site closure, by Rossetto et al, the incidence of abdominal wall hernia and bulge were significantly reduced from 5.9% to 2.5% and 17.3% to 9.9%, respectively, with the mesh (23).…”

Section: Discussionmentioning

confidence: 99%

“…For describing the abdominal bulging and hernia, abdominal bulging was defined as abdominal wall bulging without a fascial defect as assessed by physical examination, and abdominal hernia was defined as a fascial defect identified by physical examination or the need for surgical repair qualified any defect as a hernia (3,4). Final outcomes were assessed at least 1 year after surgery.…”

Section: Introductionmentioning

confidence: 99%

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Three-layer primary closure of the bipedicled TRAM flap donor site for unilateralbreast reconstruction: a 15-year experience with 124 consecutive patients

Karagöz

Şahi̇n

Sever³

et al. 2017

Turk J Med Sci

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Between 2000 and 2015, 124 patients underwent breast reconstruction with a bipedicled TRAM flap and the three-layer primary closure technique. The patient's risk Background/aim: The pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains widely used as a breast reconstruction technique. The bipedicled TRAM flap is not as preferable as it was formerly, mainly because of its donor site complications. However, in a number of situations, a bipedicled TRAM flap may be the only alternative. Therefore, a three-layer primary closure technique used with bipedicled TRAM flap breast reconstructions that can avoid donor site complications without using a mesh is presented. Materials and methods:A retrospective study was performed that included patients who underwent bipedicled TRAM flap breast reconstruction with the three-layer primary closure technique. Between 2000 and 2015, 124 breast reconstruction patients were reviewed for donor site morbidity.Results: During the 15-year study period, 106 patients had conventional bipedicled TRAM flaps and 18 had bipedicled TRAM flaps with a surgical delay procedure. For all groups, none of the patients developed abdominal wall hernia, but three patients had bulging. Partial flap loss was the most common flap complication, present in 6 flaps (4.8%). Conclusion:The suturing technique studied provided abdominal wall closure without the use of a mesh even when utilizing a bilateral pedicle with very low complication rates.

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“…Two publications with substantial numbers of patients deal with pTRAM (Kim et al [6], 500 flaps) and good results [6]. Chun et al [7] conclude presenting 105 bipedicled TRAMs: 'Bilateral pedicled TRAM flaps … remain a safe and reliable procedure, with donor-site morbidity rates that are comparable to those of other BR techniques'. Atisha et al [8] from Ann Arbor, Michigan, add new insight to the surgical delay procedure in pTRAM.…”

Section: Prognostic and Predictive Factorsmentioning

confidence: 99%

Update 2010 of the German AGO Recommendations for the Diagnosis and Treatment of Early and Metastatic Breast Cancer – Chapter A: Surgery, Pathology and Prognostic Factors, Adjuvant and Neoadjuvant Therapy, Adjuvant Radiotherapy

Thomssena

Harbeckb²

2010

Breast Care

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Outcomes and Patient Satisfaction following Breast Reconstruction with Bilateral Pedicled TRAM Flaps in 105 Consecutive Patients

Abstract: Low complication rates were demonstrated and patients were generally satisfied in this series of 105 consecutive bilateral pedicled TRAM flaps. This suggests that the bilateral pedicled TRAM flap remains a viable option for breast reconstruction.

Cited by 49 publications

References 24 publications

Patient satisfaction and health‐related quality of life after autologous tissue breast reconstruction

Patient satisfaction and health‐related quality of life after autologous tissue breast reconstruction

Three-layer primary closure of the bipedicled TRAM flap donor site for unilateralbreast reconstruction: a 15-year experience with 124 consecutive patients

Update 2010 of the German AGO Recommendations for the Diagnosis and Treatment of Early and Metastatic Breast Cancer – Chapter A: Surgery, Pathology and Prognostic Factors, Adjuvant and Neoadjuvant Therapy, Adjuvant Radiotherapy

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