title: The deep inferior epigastric perforator and pedicled transverse rectus abdominis myocutaneous flap in breast reconstruction: a comparative study.
abstract: BACKGROUND
  Our objective was to compare the complication rates of two common breast reconstruction techniques performed at our hospital and the cost-effectiveness for each test group.
  
  
  METHODS
  All patients who underwent deep inferior epigastric perforator (DIEP) flap and transverse rectus abdominis myocutaneous (TRAM) flap by the same surgeon were selected and matched according to age and mastectomy with or without axillary clearance. Patients from each resultant group were selected, with the patients matched chronologically. The remainder were matched for by co-morbidities. Sixteen patients who underwent immediate breast reconstruction with pedicled TRAM flaps and 16 patients with DIEP flaps from 1999 to 2006 were accrued. The average total hospitalisation cost, length of hospitalisation, and complications in the 2 year duration after surgery for each group were compared.
  
  
  RESULTS
  Complications arising from both the pedicled TRAM flaps and DIEP flaps included fat necrosis (TRAM, 3/16; DIEP, 4/16) and other minor complications (TRAM, 3/16; DIEP, 1/16). The mean hospital stay was 7.13 days (range, 4 to 12 days) for the pedicled TRAM group and 7.56 (range, 5 to 10 days) for the DIEP group. Neither the difference in complication rates nor in hospital stay duration were statistically significant. The total hospitalisation cost for the DIEP group was significantly higher than that of the pedicled TRAM group (P<0.001).
  
  
  CONCLUSIONS
  Based on our study, the pedicled TRAM flap remains a cost-effective technique in breast reconstruction when compared to the newer, more expensive and tedious DIEP flap.
authors.affiliation: National University Health System, National University Hospital, Singapre, Singapore.
authors.forename: Shane
authors.initials: S
authors.lastname: Tan
authors.forename: Jane
authors.initials: J
authors.lastname: Lim
authors.forename: Jacklyn
authors.initials: J
authors.lastname: Yek
authors.forename: Wei Chen
authors.initials: WC
authors.lastname: Ong
authors.forename: Chor Hoong
authors.initials: CH
authors.lastname: Hing
authors.forename: Thiam Chye
authors.initials: TC
authors.lastname: Lim
keywords: Complications; Mammoplasty; Perforator flap; Surgical flap