title: A two-year prospective analysis of trunk function in TRAM breast reconstructions.
abstract: BACKGROUND
  Functional outcomes in breast reconstruction are important quality measures and aid in patients' decision-making process. To address the concerns of abdominal wall morbidity with transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions, the authors prospectively evaluated the long-term effects of postmastectomy breast reconstruction on trunk function using objective clinical measures.
  
  
  METHODS
  Using a multicenter prospective cohort design, they recruited women undergoing first-time immediate or delayed breast reconstructions from 12 centers and 23 plastic surgeons. Trunk functional data, objectively measured with Cybex machines, for patients with an expander/implant, pedicle TRAM, and free TRAM reconstructions were evaluated preoperatively and at postoperative years 1 and 2 in 183 patients. The effects of procedure type, timing, and laterality on trunk peak torque and range of motion were analyzed using linear regression.
  
  
  RESULTS
  At 2 years postoperatively, procedure type, timing, and laterality did not significantly affect the range of motion for trunk flexion and extension. Peak torque for trunk flexion at year 2 was significantly decreased in patients with TRAM compared with expander/implant reconstructions (p < 0.05), with a 6 to 19 percent decrease in flexion peak torque. However, no significant difference in flexion peak torque was found between patients with free and pedicle TRAM reconstructions.
  
  
  CONCLUSIONS
  The authors found that (1) breast cancer patients with TRAM reconstructions had a less than 20 percent long-term deficit in trunk flexion peak torque and (2) there was no significant difference in trunk function between patients receiving pedicle and free TRAM reconstructions.
authors.affiliation: Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical Center, Ann Arbor, USA. aalder@umich.edu
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
authors.forename: William M
authors.initials: WM
authors.lastname: Kuzon
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Wilkins
mesh_terms: D001696:Biomechanical Phenomena; D019928:Breast Implantation / Q000534:rehabilitation*; D001943:Breast Neoplasms / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007700:Kinetics; D016462:Mammaplasty / Q000379:methods / Q000534:rehabilitation*; D008408:Mastectomy / Q000534:rehabilitation; D008875:Middle Aged; D018583:Pliability; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D017568:Rectus Abdominis / Q000637:transplantation; D013524:Surgical Flaps; D013997:Time Factors; D015626:Tissue Expansion / Q000534:rehabilitation*; D019415:Torque