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A Prospective Study Comparing the Functional Impact of SIEA, DIEP, and Muscle-Sparing Free TRAM Flaps on the Abdominal Wall: Part I. Unilateral Reconstruction

Selber, Jesse C. M.D., M.P.H.; Nelson, Jonas M.D.; Fosnot, Joshua M.D.; Goldstein, Jesse M.D.; Bergey, Meredith M.Sc.; Sonnad, Seema S. Ph.D.; Serletti, Joseph M. M.D.

Plastic and Reconstructive Surgery: October 2010 - Volume 126 - Issue 4 - p 1142-1153
doi: 10.1097/PRS.0b013e3181f02520
Breast: Outcomes Articles

Background: The purpose of this two-part study was to demonstrate the impact of free flap breast reconstruction on the abdominal wall. In Part I, the authors present the results for unilateral techniques.

Methods: A blinded, prospective, cohort study was performed involving 234 free flap breast reconstruction patients. Patients were evaluated preoperatively, and followed for 1 year. At each encounter, patients underwent abdominal strength testing using the Upper and Lower Rectus Abdominis Manual Muscle Function Test, the Functional Independence Measure, and psychometric testing using the 36-Item Short-Form Health Survey. Patients also completed a satisfaction questionnaire specific to breast reconstruction. Statistical analysis included the Kruskal-Wallis, Mann-Whitney, Friedman, and Wilcoxon signed rank tests.

Results: Two-hundred thirty-four patients were enrolled. Of these, 157 underwent reconstruction (75 of which were unilateral), completed follow-up, and were included in the analysis. There was a significantly greater decline in upper abdominal strength in patients undergoing muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flap surgery compared with deep inferior epigastric perforator (DIEP) flap surgery at early (p = 0.01) and late follow-up (p = 0.02). Unilateral superficial inferior epigastric artery flap procedures (n = 3) were too few for a meaningful conclusion to be reached. Lower abdominal and Functional Independence Measure scores showed no significant differences. Psychometric testing showed that there was a significant decline in physical health within the free TRAM flap group. No significant difference among groups was appreciable.

Conclusion: In unilateral cases, the impact of the muscle-sparing free TRAM flap versus the DIEP flap follows theoretical predictions based on the degree of muscle sacrifice: the muscle-sparing free TRAM flap demonstrated a greater decline than the DIEP flap in certain measurable parameters.

Houston, Texas; Philadelphia, Pa.; and Washington, D.C.

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center; the Divisions of Plastic Surgery and Biostatistics, University of Pennsylvania; and the Department of Plastic Surgery, Georgetown University.

Received for publication February 27, 2010; accepted April 14, 2010.

Presented in part at the 24th Annual Meeting of the Northeastern Society of Plastic Surgeons, in Southampton, Bermuda, October 3 through 6, 2007.

Disclosure: No authors involved in the production of this article have any commercial associations that might pose or create a conflict of interest with information presented herein. No intramural or extramural funding supported any aspect of this work.

Jesse C. Selber, M.D., M.P.H., Department of Plastic Surgery, Unit 443; University of Texas M. D. Anderson Cancer Center; 1515 Holcombe Boulevard; Houston, Texas 77030; JCSelber@mdanderson.org

©2010American Society of Plastic Surgeons