Comparison of Outcomes following Autologous Breast Reconstruction Using the DIEP and Pedicled TRAM Flaps: A 12-Year Clinical Retrospective Study and Literature Review.
BACKGROUND
There are few studies that compare the deep inferior epigastric artery perforator (DIEP) flap to the pedicled transverse rectus abdominis myocutaneous (pTRAM) flap for use in reconstructive breast surgery. The authors examined four factors that aid in decision-making: donor-site morbidity, need for surgery related to abdominal morbidity, operative time, and complications.


METHODS
This is a retrospective review of patients undergoing breast reconstruction using the DIEP or pTRAM flap at the University of British Columbia between 2002 and 2013. The authors compared operative time and abdomen- and flap-related complications in both groups.


RESULTS
Reconstruction was performed in 507 patients; 25.6 percent received DIEP flaps (n = 183 breasts) and 74.4 percent underwent pTRAM flap surgery (n = 444 breasts). Pedicled TRAM flap patients were more likely to require abdominal closure with mesh (44.2 percent versus 8.1 percent; p < 0.001); 21.2 percent of them had a postoperative bulge and/or hernia versus 3.1 percent of DIEP flap patients; and 12.7 percent of pTRAM flap patients required surgery for hernia/bulge. Controlling for confounders, there were five times the odds of a hernia/bulge in the pTRAM flap group. DIEP flap surgery was 234 minutes longer than pTRAM flap surgery.


CONCLUSIONS
The benefits of the pTRAM flap may be offset by the need to correct abdominal wall complications. DIEP flap reconstruction had lower donor complications but increased operative time. A cost analysis is needed to determine the most economical procedure.


METHODS
Therapeutic, III.
Vancouver, British Columbia, Canada.|From the Division of Plastic Surgery, University of British Columbia, Vancouver General Hospital, and the Department of Internal Medicine, Faculty of Medicine, University of British Columbia.
Aaron D C
ADC
Knox
Vancouver, British Columbia, Canada.|From the Division of Plastic Surgery, University of British Columbia, Vancouver General Hospital, and the Department of Internal Medicine, Faculty of Medicine, University of British Columbia.
Adelyn L
AL
Ho
Vancouver, British Columbia, Canada.|From the Division of Plastic Surgery, University of British Columbia, Vancouver General Hospital, and the Department of Internal Medicine, Faculty of Medicine, University of British Columbia.
Leslie
L
Leung
Vancouver, British Columbia, Canada.|From the Division of Plastic Surgery, University of British Columbia, Vancouver General Hospital, and the Department of Internal Medicine, Faculty of Medicine, University of British Columbia.
A Yashar
AY
Tashakkor
Vancouver, British Columbia, Canada.|From the Division of Plastic Surgery, University of British Columbia, Vancouver General Hospital, and the Department of Internal Medicine, Faculty of Medicine, University of British Columbia.
Peter A
PA
Lennox
Vancouver, British Columbia, Canada.|From the Division of Plastic Surgery, University of British Columbia, Vancouver General Hospital, and the Department of Internal Medicine, Faculty of Medicine, University of British Columbia.
Nancy
N
Van Laeken
Vancouver, British Columbia, Canada.|From the Division of Plastic Surgery, University of British Columbia, Vancouver General Hospital, and the Department of Internal Medicine, Faculty of Medicine, University of British Columbia.
Sheina A
SA
Macadam
D001943:Breast Neoplasms / Q000601:surgery*; D019074:Epigastric Arteries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D061525:Perforator Flap / Q000098:blood supply*; D017568:Rectus Abdominis / Q000637:transplantation*; D012189:Retrospective Studies; D014182:Transplantation, Autologous