Delayed Pedicled TRAM versus Free Flap for Breast Reconstruction: Comparison of Outcomes
Anne Argenta, MD, James Cray, PhD, Kenneth Shestak, MD, Vu Nguyen, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
BACKGROUND: Previous studies have validated the safety and efficacy of two common methods of breast reconstruction: free flaps and immediate pedicled TRAM flaps. However, there remains considerable debate regarding which technique is superior. One advancement in pedicled reconstruction is the “delay phenomenon,” resulting over time in increased capacity of the flap’s dominant vessel, with potentially less compromise and loss of tissue. This study compares outcomes of delayed pedicled TRAM vs free flap reconstruction for post mastectomy breast reconstruction.
METHODS: Two patient populations, those who underwent delayed pedicled TRAM and those who underwent free flap (MSFTRAM, DIEP, and/or SIEP), were compared. All cases were performed by two specialists at our university between 2004 and 2008. Hospital and outpatient records were retrospectively reviewed. Collected data included patient demographics, operative details, and complications.
RESULTS: 44 free flap cases (21 bilateral) and 24 delayed pedicled TRAM cases (5 bilateral) were reviewed. The two groups were comparable in patient demographics, one exception being that delayed pedicled group had more patients with preoperative radiation. The groups were also comparable in total operative time, blood loss, length of hospital stay, and length of follow up. No flaps suffered complete loss in either group. The pedicled TRAM group had higher rates of fat necrosis, while the free flap group had higher rates of hematoma, delayed wound healing, and use of postoperative antibiotics. Both groups had similar rates of secondary surgery for complications or cosmetic revisions.
CONCLUSION: Both options for breast reconstruction are valid. Difference in complications related to radiation and wound healing underscore the importance of individualized reconstruction for selected patient groups.
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