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

Technical advancements in abdominal flap-based autologous breast reconstruction (ABR) have focussed on minimizing abdominal wall morbidity. However, no consensus exists on the technique that maximises abdominal function, particularly in cases of bilateral ABR. This systematic review critically appraises the literature to assess abdominal wall function following abdominal flap-based ABR.

A literature search was performed following PRISMA guidelines. Four databases (Embase (via Ovid), Medline (via Ovid), Cochrane Library and PubMed) were searched. The primary outcome was abdominal wall function following abdominal flap-based ABR measured by sit-up performance, manual muscle function testing, isokinetic dynamometry and ultrasound.

38 studies were included comparing various types of abdominally-based autologous flaps used for breast reconstruction. Sit-up ability was highest in DIEP group (87%) when compared to free TRAM (25%) and pedicled TRAM (12%). Bilateral DIEP had higher combined mean upper rectus and lower rectus abdominis function scores (4.54) compared to bilateral free TRAM (3.87), where 5 represents normal function. Bilateral ABR demonstrated worse abdominal function compared with unilateral ABR in all flap types.

DIEP flaps yield superior abdominal muscle function outcomes compared to TRAM flaps of all types, particularly when performing bilateral ABR. Future research should aim to standardise abdominal function measurement and reporting of intra-operative variables, such as the length of fascial and muscle incisions, the number of abdominal motor nerve branches sacrificed, and the use of abdominal mesh to enable more complete understanding of the impact of abdominal flap-based ABR on abdominal wall function.