title: Abdominal wall morbidity following unilateral and bilateral breast reconstruction with pedicled TRAM flaps: an outcomes analysis of 117 consecutive patients.
abstract: BACKGROUND
  Recently, there has been increasing concern regarding the potential for abdominal wall morbidity following breast reconstruction with pedicled transverse rectus abdominis myocutaneous (TRAM) flaps. The purpose of this study was to analyze a large, consecutive series of pedicled TRAM flaps performed by a single surgeon and examine the incidence of abdominal morbidity.
  
  
  METHODS
  Between December of 1998 and June of 2005, 117 women underwent breast reconstruction with pedicled TRAM flaps by the senior author (J.A.A.). All abdominal repairs were reinforced with polypropylene mesh. Reconstruction was unilateral in 105 women (90 percent) and bilateral in 12 women (10 percent). The charts were reviewed retrospectively for abdominal complications and associated demographics.
  
  
  RESULTS
  The mean follow-up period was 23.3 months. In the 117 patients, there was one hernia (0.85 percent), two abdominal wall bulges (1.7 percent), two superficial infections (1.7 percent), one partial skin loss (0.85 percent), one hematoma (0.85 percent), and zero seromas. Three patients (2.6 percent) had prolonged abdominal wall discomfort/tightness that was treated successfully with physical therapy. No patient developed a mesh infection or required mesh removal secondary to infection or exposure. In addition, no patient complained of persistent abdominal weakness, and there were no TRAM flap losses.
  
  
  CONCLUSIONS
  Although many authors have reported concern over potentially high rates of abdominal wall morbidity following pedicled TRAM flaps, abdominal complication rates in the current series were uniformly low. The authors therefore believe that pedicled TRAM flaps remain a good option for many women seeking breast reconstruction.
authors.affiliation: New York, N.Y. From the Division of Plastic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Ascherman
authors.forename: Mitchel
authors.initials: M
authors.lastname: Seruya
authors.forename: Sophie A
authors.initials: SA
authors.lastname: Bartsich
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013526:Surgical Mesh