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Abdominal sequelae after pedicled TRAM flap breast reconstruction
J Y Petit1, M Rietjens, M A Ferreira
1Institut Gustave-Roussy, Villejuif, France.
Plastic and Reconstructive Surgery
|March 1, 1997
Summary
Transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction offers good cosmetic results but carries risks of abdominal scarring, weakness, and back pain. Patients should be fully informed about these potential abdominal sequelae before undergoing the procedure.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Oncology
Background:
- Growing interest in autologous tissue breast reconstruction due to concerns over silicone implants.
- Transverse Rectus Abdominis Musculocutaneous (TRAM) flap is a popular autologous technique.
- Potential for abdominal sequelae requires thorough patient counseling.
Purpose of the Study:
- To evaluate the cosmetic outcomes and abdominal sequelae of TRAM flap breast reconstruction.
- To assess the impact on abdominal strength and patient-reported pain.
- To compare outcomes between single-pedicled and bipedicled TRAM flaps.
Main Methods:
- Retrospective review of TRAM flap breast reconstructions performed before 1991.
- Cosmetic assessment of abdominal photographs by independent judges.
- Muscular strength testing pre- and post-operatively.
- Patient-reported pain assessment at 6 months post-surgery.
Main Results:
- 70% of patients had a "natural" abdominal appearance; however, 25% found the umbilical scar unacceptable and 35% the lower abdominal scar "not acceptable".
- Significant impairment of rectus abdominis and oblique muscle function observed in 50-60% of patients, more severe in bipedicled flaps.
- Postoperative back pain was reported by 55% (single-pedicle) and 30% (double-pedicle) for mild pain, with 20% of double-pedicle patients experiencing severe pain.
Conclusions:
- Abdominal sequelae, including scarring, weakness, and pain, are significant drawbacks of TRAM flap breast reconstruction.
- The risks associated with TRAM flap surgery should not be underestimated.
- Autologous reconstruction outcomes must be weighed against prosthetic options considering all potential complications.