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Safety and Risk Factors for Breast Reconstruction With Pedicled Transverse Rectus Abdominis Musculocutaneous Flaps: A 10-Year Analysis

Ducic, Ivica MD, PhD; Spear, Scott L. MD; Cuoco, Frank MD; Hannan, Catherine MD

doi: 10.1097/01.sap.0000184463.90172.04
Original Article
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Background: The purpose of this study is to examine the effect of various risk factors on complications in patients undergoing pedicled transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction.

Methods: A retrospective review of 224 pedicled TRAMs in 200 patients over a 10-year period was carried out. Patients were divided into subgroups based on smoking history, weight, radiation status, and pedicle type. Complication rates were calculated and logistic regression analysis was used to identify risk factors.

Results: Logistic regression identified active smoking as a statistically significant risk factor for developing multiple (2 or more) flap complications (P = 0.0061) and TRAM infection (P = 0.0255), while former smoking was a risk factor for multiple flap complications (P = 0.01) and TRAM-delayed wound healing (P = 0.0433). Obesity (body mass index ≥30) was found to be a statistically significant risk factor for overall (1 or more) donor-site complications (P = 0.0281), overall flap complications (P = 0.0375), multiple flap complications (P = 0.0002), TRAM-delayed wound healing (P = 0.0334), and minor flap necrosis (P = 0.0075).

Conclusions: This study identified that active or former smoking and obesity contribute to a significant complication rate, while overweight body habitus, use of double-pedicled flaps, and pre-TRAM radiation do not. This second decade “look-back” on pedicled TRAM flap breast reconstruction emphasizes the need for appropriate patient selection to achieve successful results with pedicled TRAM breast reconstruction.

A retrospective review of 224 pedicled TRAM breast reconstructions in 200 patients identified active or former smoking and obesity as contributing factors to higher complication rates. Overweight body habitus, use of double-pedicled flaps, and pre-TRAM radiation did not show higher complication rates.

From the Department of Plastic Surgery, Georgetown University Medical Center, Washington, DC.

Received May 24, 2005, and accepted for publication, after revision, August 7, 2005.

Reprints: Scott L. Spear, MD, Division of Plastic Surgery, Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, DC 20007. E-mail: plasticsurgery@gunet.georgetown.edu.

© 2005 Lippincott Williams & Wilkins, Inc.