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Optimizing Autologous Breast Reconstruction in Thin Patients

Kronowitz, Steven J. M.D.; Robb, Geoffrey L. M.D.; Youssef, Adel M.D., Ph.D.; Reece, Gregory M.D.; Chang, Shih-Hsin M.D.; Koutz, Cynthia A. M.S., P.A.-C.; Ng, Roy L. H. M.A., D.M.; Lipa, Joan E. M.D., M.Sc.; Miller, Michael J. M.D.

Plastic and Reconstructive Surgery: December 2003 - Volume 112 - Issue 7 - p 1768-1778
doi: 10.1097/01.PRS.0000090541.54788.AD

Breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap plus an implant has been proposed as an option for women with a thin body habitus who do not have sufficient abdominal tissue to permit reconstruction with a TRAM flap alone. The standard autologous tissue reconstructive procedure in these women is a combined latissimus dorsi myocutaneous flap and breast implant. We reviewed our experience performing TRAM flap/implant and latissimus dorsi flap/implant breast reconstruction to compare complication rates and aesthetic outcomes between these two types of reconstruction. Between 1992 and 1999, 88 breasts were reconstructed at our institution using an autologous tissue flap combined with a breast implant (44 with a TRAM flap/implant and 44 with a latissimus dorsi flap/implant). Recipient-site and donor-site complications for the two procedures were compared using Fisher’s exact test; a panel of nonbiased, blinded judges compared the aesthetic outcomes. The recipient-site complication rate was lower for the TRAM flap/implant group than for the latissimus dorsi flap/implant group (18 percent versus 34 percent, p = 0.09). Most recipient-site complications in the TRAM flap/implant group were related to fluid collection around the implant. In the TRAM flap/implant group, complications occurred in 37 percent of the reconstructions that had immediate implant placement and in none of the reconstructions with delayed implant placement (p = 0.01). In the TRAM flap/implant reconstructions with immediate implant placement, the recipient-site complication rate was 50 percent when implants were completely filled with saline, but no complications occurred with incompletely filled, postoperatively adjustable implants (p = 0.03). No microvascular complications occurred with immediate placement of breast implants under TRAM flaps. Donor-site complications included a hematoma, a seroma, and an umbilical necrosis in the TRAM flap/implant group and six cases of seroma formation in the latissimus dorsi flap/implant group. The comparison of aesthetic outcome was statistically significant for the TRAM flap/implant group, which had a higher overall mean score than the latissimus dorsi flap/implant group did (3.29 versus 2.85, p = 0.01). The results of this study suggest that the TRAM flap/implant breast reconstruction should be considered as an alternative to the latissimus dorsi flap/implant breast reconstruction in women with a thin body habitus.

Houston, Texas

From the Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center.

Received for publication May 29, 2002;

revised February 7, 2003.

Steven J. Kronowitz, M.D.

Department of Plastic Surgery, Box 443

The University of Texas M. D. Anderson Cancer Center

1515 Holcombe Blvd.

Houston, Texas 77030

Presented at the 81st Annual Meeting of the American Association of Plastic Surgeons, in Seattle, Washington, April 26 to 29, 2002.

©2003American Society of Plastic Surgeons