Outcomes and patient satisfaction following breast reconstruction with bilateral pedicled TRAM flaps in 105 consecutive patients.

BACKGROUND: Breast reconstruction using pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps has come under increasing scrutiny secondary to presumed abdominal wall morbidity. This study analyzes morbidity and patient satisfaction in a consecutive series of breast reconstructions performed using bilateral pedicled TRAM flaps.

METHODS: Between 1991 and 2007, 105 women underwent bilateral pedicled TRAM flap breast reconstruction performed by the senior author (J.J.P.). Charts were reviewed for postoperative complications and demographic data. Minimum 11-month follow-up survey data were obtained through the Michigan Breast Satisfaction Questionnaire, the Qualitative Assessment of Back Pain Questionnaire, and the Short Form-36 questionnaire.

RESULTS: The mean follow-up interval was 6 years. Abdominal wall complications included three abdominal hernias (2.9 percent), three abdominal wall bulges (2.9 percent), and four partial donor-site skin dehiscences (3.8 percent). Fat necrosis was the most common flap complication, present in 24 flaps (11.4 percent). The survey response rate was 61.9 percent. Short Form-36 data demonstrated no significant difference from a mean age-matched female population in general well-being, although patients with a body mass index greater than or equal to 30 reported significantly lower emotional well-being (p = 0.01), social functioning (p = 0.03), and overall energy scores (p = 0.03) in comparison with patients with a body mass index less than 30. Thirteen of the 65 patients who completed the survey (20 percent) complained of postoperative back pain, although most of these patients reported their symptoms to be mild in nature.

CONCLUSIONS: Low complication rates were demonstrated and patients were generally satisfied in this series of 105 consecutive bilateral pedicled TRAM flaps. This suggests that the bilateral pedicled TRAM flap remains a viable option for breast reconstruction.