A two-year prospective analysis of trunk function in TRAM breast reconstructions

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Oncology

Background:

• Functional outcomes are crucial quality measures in breast reconstruction.
• Concerns exist regarding abdominal wall morbidity with Transverse Rectus Abdominis Musculocutaneous (TRAM) flap reconstructions.
• Objective evaluation of long-term trunk function after postmastectomy breast reconstruction is needed.

Purpose of the Study:

• To prospectively evaluate the long-term effects of different postmastectomy breast reconstruction methods on trunk function.
• To compare objective clinical measures of trunk function between expander/implant, pedicle TRAM, and free TRAM reconstructions.

Main Methods:

• Multicenter prospective cohort study involving 183 women undergoing breast reconstruction.
• Objective trunk functional data (peak torque, range of motion) measured using Cybex machines preoperatively and at 1 and 2 years postoperatively.
• Linear regression analysis to assess the effects of procedure type, timing, and laterality.

Main Results:

• No significant difference in trunk flexion/extension range of motion at 2 years postoperatively based on procedure type, timing, or laterality.
• Significantly decreased trunk flexion peak torque (6-19%) at 2 years in TRAM flap patients compared to expander/implant (p < 0.05).
• No significant difference in trunk flexion peak torque between free TRAM and pedicle TRAM reconstructions.

Conclusions:

• TRAM flap breast reconstruction is associated with a long-term trunk flexion peak torque deficit of less than 20%.
• Trunk function outcomes are comparable between pedicle TRAM and free TRAM reconstructions.
• Expander/implant reconstruction demonstrates superior long-term peak torque compared to TRAM flaps.