Abdominal Function Following Breast Reconstruction with Abdominal Tissue Flaps: A Systematic Review

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Autologous Breast Reconstruction

Background:

• Technical advancements in autologous breast reconstruction (ABR) aim to reduce abdominal wall morbidity.
• Optimal technique for maximizing abdominal function, especially in bilateral ABR, remains unclear.

Purpose of the Study:

• To systematically review and critically appraise the literature on abdominal wall function after abdominal flap-based ABR.
• To compare functional outcomes across different abdominal flap techniques.

Main Methods:

• Systematic literature search following PRISMA guidelines across four major databases.
• Primary outcome: abdominal wall function assessed via sit-up performance, manual muscle testing, isokinetic dynamometry, and ultrasound.

Main Results:

• 38 studies compared various abdominal flap types for breast reconstruction.
• DIEP flaps showed significantly higher sit-up ability (87%) versus free TRAM (25%) and pedicled TRAM (12%).
• Bilateral DIEP flaps demonstrated superior rectus abdominis muscle function scores compared to bilateral free TRAM flaps.

Conclusions:

• DIEP flaps provide superior abdominal muscle function outcomes compared to TRAM flaps, particularly in bilateral ABR.
• Standardization of abdominal function measurement and intra-operative variable reporting is crucial for future research.