Satisfaction following Unilateral Breast Reconstruction: A Comparison of Pedicled TRAM and Free Abdominal Flaps.
BACKGROUND
The purpose of this study was to compare patient satisfaction following unilateral pedicled transverse rectus abdominis myocutaneous (TRAM) and free abdominal flap reconstruction.


METHODS
Patients who underwent unilateral breast reconstruction using pedicled TRAM or free abdominal flaps (muscle-sparing TRAM or deep inferior epigastric perforator flap) and completed the BREAST-Q were identified from 2 prospectively maintained databases. BREAST-Q scores were assessed and compared for Satisfaction with Breasts, Outcome, and Physical Well-being Chest/Abdomen.


RESULTS
Of the 138 patients who completed the BREAST-Q, 84 underwent pedicled TRAM flap reconstruction and 54 underwent free abdominal flap reconstruction. Overall, pedicled TRAM flap patients scored higher than free abdominal flap patients on all 4 BREAST-Q scales. This difference reached statistical significance in Satisfaction with Breasts (+7.74; P = 0.02). Similar results were found among patients who completed the BREAST-Q at <3 years postoperation. However, among patients at ≥3 years postoperation, there were no statistically significant differences between the 2 groups, with the pedicled flap cohort scoring higher in Satisfaction with Breasts and Physical Well-being Chest and the free abdominal flap cohort scoring higher in Satisfaction with Outcome and Physical Well-being Abdomen scores.


CONCLUSIONS
Patients who underwent unilateral pedicled TRAM flap reconstruction experienced greater initial breast satisfaction than patients who underwent unilateral free abdominal flap reconstruction, but satisfaction equalized between the two over time, suggesting that long-term satisfaction may be equivalent between the 2 methods of reconstruction.
Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.; and Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Jonathan A
JA
Schwitzer
Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.; and Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
H Catherine
HC
Miller
Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.; and Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Andrea L
AL
Pusic
Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.; and Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Evan
E
Matros
Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.; and Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Babak J
BJ
Mehrara
Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.; and Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Colleen M
CM
McCarthy
Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.; and Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Peter A
PA
Lennox
Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.; and Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Nancy
N
Van Laeken
Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y.; and Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Joseph J
JJ
Disa