Comparison of
Outcomes following Autologous Breast Reconstruction Using the DIEP and
Pedicled TRAM Flaps: A 12-Year Clinical Retrospective Study and
Literature Review
Plastic and Reconstructive Surgery
Knox AD, et al
Background: There are few studies that compare the deep inferior
epigastric artery perforator (DIEP) flap to the pedicled transverse
rectus abdominis myocutaneous (pTRAM) flap for use in reconstructive
breast surgery. The authors examined four factors that aid in
decision-making: donor-site morbidity, need for surgery related to
abdominal morbidity, operative time, and complications.
Methods: This is a retrospective review of patients undergoing breast
reconstruction using the DIEP or pTRAM flap at the University of British
Columbia between 2002 and 2013. The authors compared operative time and
abdomen- and flap-related complications in both groups.
Results: Reconstruction was performed in 507 patients; 25.6 percent
received DIEP flaps (n = 183 breasts) and 74.4 percent underwent pTRAM
flap surgery (n = 444 breasts). Pedicled TRAM flap patients were more
likely to require abdominal closure with mesh (44.2 percent versus 8.1
percent; p < 0.001); 21.2 percent of them had a postoperative bulge
and/or hernia versus 3.1 percent of DIEP flap patients; and 12.7 percent
of pTRAM flap patients required surgery for hernia/bulge. Controlling
for confounders, there were five times the odds of a hernia/bulge in the
pTRAM flap group. DIEP flap surgery was 234 minutes longer than pTRAM
flap surgery.
Conclusions: The benefits of the pTRAM flap may be offset by the need to
correct abdominal wall complications. DIEP flap reconstruction had
lower donor complications but increased operative time. A cost analysis
is needed to determine the most economical procedure.
