title: The management of abdominal contour defects following TRAM flap breast reconstruction.
abstract: BACKGROUND
  Incisional hernia can develop following breast reconstruction with abdominal tissue regardless of technique, and the management is often challenging.
  
  
  OBJECTIVE
  The authors characterize hernias following transverse rectus abdominis musculocutaneous (TRAM) flap procedures and evaluate outcomes of different strategies for repair.
  
  
  METHODS
  All patients who underwent repair of a TRAM-related hernia or bulge between 2003 and 2011 at a single institution were retrospectively reviewed. A minimum of 2 years' follow-up was required for inclusion in this series. Outcomes of different techniques for repair were compared and risk factors for hernia recurrence identified.
  
  
  RESULTS
  Forty-three patients underwent repair of a TRAM-related hernia or bulge, most often with mesh (74.4%, n=32). At a mean overall follow-up of 5.2 years, 9 patients (20.9%) developed recurrent hernia or bulge. Compared to primary suture closure, the use of mesh was protective against recurrence (odds ratio, 0.05; 95% confidence interval, 0.00-0.65; P=.02), with the best results observed with fascial closure and underlay mesh reinforcement.
  
  
  CONCLUSIONS
  Incisional hernia following TRAM flap breast reconstruction can be a challenging problem. Attention to surgical technique and the use of mesh minimize the risk of recurrence.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Emory University, Atlanta, Georgia.
authors.forename: Ximena A
authors.initials: XA
authors.lastname: Pinell-White
authors.forename: Sameer M
authors.initials: SM
authors.lastname: Kapadia
authors.forename: Albert
authors.initials: A
authors.lastname: Losken
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000601:surgery*; D017568:Rectus Abdominis / Q000637:transplantation; D012008:Recurrence; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D013524:Surgical Flaps; D013526:Surgical Mesh
keywords: TRAM flap; abdominal hernia; autologous flaps; breast reconstruction; breast surgery; postoperative complications