title: Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors: A Multicenter Comparison of Four Abdominally Based Autologous Reconstruction Methods.
abstract: BACKGROUND
  Approximately 20 percent of women select autologous tissue for postmastectomy breast reconstruction, and most commonly choose the abdomen as the donor site. An increasing proportion of women are seeking muscle-sparing procedures, but the benefit remains controversial. It is therefore important to determine whether better outcomes are associated with these techniques, thereby justifying longer operative times and increased costs.
  
  
  METHODS
  Patients from five North American centers were eligible if they underwent reconstruction by means of the deep inferior epigastric artery perforator (DIEP) flap, muscle-sparing free transverse abdominis myocutaneous (TRAM) flap, free TRAM flap, or the pedicled TRAM flap. Patients were sent the BREAST-Q. Demographics and complications were collected.
  
  
  RESULTS
  The authors analyzed 1790 charts representing 670 DIEP, 293 muscle-sparing free TRAM, 683 pedicled TRAM, and 144 free TRAM patients with an average follow-up of 5.5 years. Flap loss did not differ by flap type. Partial flap loss was higher in pedicled TRAM compared with DIEP (p = 0.002). Fat necrosis was higher in pedicled TRAM compared with DIEP and muscle-sparing free TRAM (p < 0.001). Hernia/bulge was highest in pedicled TRAM (p < 0.001). Physical well-being (abdomen) scores were higher in DIEP compared with pedicled TRAM controlling for confounders.
  
  
  CONCLUSIONS
  Complications and patient-reported outcomes differ when comparing abdominally based breast reconstruction techniques. The results of this study show that the DIEP flap was associated with the highest abdominal well-being and the lowest abdominal morbidity compared with the pedicled TRAM flap, but did not differ from muscle-sparing free TRAM and free TRAM flaps.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Vancouver, British Columbia, and Toronto, Ontario, Canada; and New York, N.Y. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, the Department of Psychology, University of British Columbia; the Division of Plastic and Reconstructive Surgery, University Health Network, University of Toronto; the Department of Surgery, Division of Plastic and Reconstructive Surgery Montefiore Medical Center; New York Medical Center, New York University; and the Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center.
authors.forename: Sheina A
authors.initials: SA
authors.lastname: Macadam
authors.forename: Toni
authors.initials: T
authors.lastname: Zhong
authors.forename: Katie
authors.initials: K
authors.lastname: Weichman
authors.forename: Michael
authors.initials: M
authors.lastname: Papsdorf
authors.forename: Peter A
authors.initials: PA
authors.lastname: Lennox
authors.forename: Alexes
authors.initials: A
authors.lastname: Hazen
authors.forename: Evan
authors.initials: E
authors.lastname: Matros
authors.forename: Joseph
authors.initials: J
authors.lastname: Disa
authors.forename: Babak
authors.initials: B
authors.lastname: Mehrara
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D019074:Epigastric Arteries / Q000601:surgery / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods* / Q000523:psychology*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply* / Q000637:transplantation; D063868:Patient Outcome Assessment; D061525:Perforator Flap / Q000098:blood supply / Q000637:transplantation*; D011788:Quality of Life; D017568:Rectus Abdominis / Q000601:surgery / Q000637:transplantation; D018570:Risk Assessment; D057566:Self Report; D011795:Surveys and Questionnaires; D017741:Survivors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014481:United States