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Sensibility following Innervated Free TRAM Flap for Breast Reconstruction: Part II. Innervation Improves Patient-Rated Quality of Life

Temple, Claire L. F. M.D.; Ross, Douglas C. M.D., M.Ed.; Kim, Sharon M.D.; Tse, Raymond M.D.; Bettger-Hahn, Margo M.Sc.N.; Gan, Bing Siang M.D., Ph.D.; MacDermid, Joy B.Sc.P.T., M.Sc., Ph.D.

Plastic and Reconstructive Surgery: November 2009 - Volume 124 - Issue 5 - p 1419-1425
doi: 10.1097/PRS.0b013e3181b98963
Breast: Original Articles

Background: Restoring sensory innervation may be a useful adjunct in free flap head and neck reconstruction but, as yet, has not been shown to improve outcomes of breast reconstruction. The authors’ previous study demonstrated objectively improved sensation in a group of innervated transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction patients relative to noninnervated flaps. This study compared patient-rated outcomes of free TRAM breast reconstruction in innervated versus noninnervated flaps.

Methods: Twenty-seven women were randomized prospectively to undergo either innervated or noninnervated free TRAM flap breast reconstruction. For innervated flaps, the T10 intercostal nerve was harvested with the TRAM flap and neurotized to the T4 sensory nerve at the recipient site. Three validated outcome tools were administered after surgery: the Medical Outcomes Study 36-Item Short Form Health Survey, the Body Image after Breast Cancer Questionnaire, and the Functional Assessment of Cancer Therapy–Breast. Results were correlated with previously reported objective sensibility outcomes.

Results: Eighteen of 27 women returned their questionnaires a mean 48 months after free TRAM flap reconstruction. Demographic analysis revealed no significant differences in patient age, height, smoking, radiation therapy, and nipple-areola complex reconstruction between randomized patient groups. There was a statistically significant improvement in all three measures in patients who were randomized to receive innervated free TRAM flaps compared with those receiving noninnervated flaps.

Conclusion: This study demonstrates that innervation of free TRAM flaps used for breast reconstruction not only improves sensibility but also has a positive effect on patient-rated quality of life.

London, Ontario, Canada

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Lawson Health Research Institute, University of Western Ontario.

Received for publication October 13, 2008; accepted May 4, 2009.

Presented at the 59th Annual Meeting of the Canadian Society of Plastic Surgeons, in Nanaimo, British Columbia, June 8 through 11, 2005.

Disclosure: The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article.

Douglas C. Ross, M.D., M.Ed., St. Joseph’s Health Centre, 268 Grosvenor Street, Room D0-210, London, Ontario N6A 4L6, Canada,

©2009American Society of Plastic Surgeons