Microvascular breast reconstruction in the diabetic patient.
BACKGROUND
The free transverse rectus abdominis musculocutaneous (TRAM) flap is frequently advocated for autogenous breast reconstruction following mastectomy. The success rate and complications associated with free TRAM flap breast reconstruction are well documented. Risk factors such as cigarette smoking and obesity have been studied. Because of abnormalities in endothelial and red cell function, platelet function, altered blood viscosity, and abnormal intimal repair, diabetes mellitus is generally considered to be a risk factor for free TRAM flap breast reconstruction. The success rate of microvascular TRAM flap breast reconstruction in patients with diabetes mellitus has not been clearly defined.


METHODS
A retrospective review of 893 free TRAM flaps used for breast reconstruction in 763 patients at a single institution was performed. All flaps were performed at M. D. Anderson Cancer Center after January 1, 1985, and before December 31, 1997. Patients were classified as insulin-dependent (type 1) diabetic, non-insulin-dependent (type 2) diabetic, and nondiabetic. Flap and donor-site complications were compared among the three groups. Multivariate statistical analysis was used to examine demographic characteristics, body mass index, comorbid conditions, preoperative radiation therapy, immediate versus delayed reconstruction, and smoking history in patients with type 1 diabetes mellitus, type 2 diabetes mellitus, and nondiabetic patients.


RESULTS
The incidence of flap complications did not differ significantly between type 1 diabetics, type 2 diabetics, and nondiabetic patients. The incidence of donor-site complications did not differ significantly between type 1 diabetics, type 2 diabetics, and nondiabetic patients.


CONCLUSIONS
The present data indicate that type 1 diabetes mellitus and type 2 diabetes mellitus are not relative or absolute contraindications to microvascular TRAM flap breast reconstruction.
Miller
Randy B
RB
Houston, Texas; and Irvine, Calif. From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center; Division of Plastic Surgery, Baylor College of Medicine; and Division of Plastic Surgery, University of California, Irvine.
Reece
Gregory
G
Kroll
Stephen S
SS
Chang
David
D
Langstein
Howard
H
Ziogas
Argyrios
A
Robb
Geoffrey
G
Evans
Gregory R D
GRD
D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D048909:Diabetes Complications / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008833:Microcirculation; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D014656:Vascular Surgical Procedures / Q000379:methods