Autologous Breast Reconstruction with Transverse Rectus Abdominis Musculocutaneous (TRAM) or Deep Inferior Epigastric Perforator (DIEP) Flaps: An Analysis of the 100 Most Cited Articles

Abstract

Post-mastectomy autologous reconstruction with abdominal tissue has evolved over the past 4 decades and is a common reconstructive modality today. To gain more insight into this evolution, we performed an analysis of the 100 most commonly cited articles focusing on autologous breast reconstruction with transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flaps. A review of the ISI Web of Knowledge database was performed. Only peer-reviewed articles in English were included for analysis. Articles were ranked by their total citations as well as citation density (citations divided by years since publication). The 100 most cited articles were analyzed by their bibliographic parameters. The 100 most cited articles were published in 12 journals. The highest ranked plastic surgery journal published almost 2/3 of the articles. All articles were published within 23 years and marked the “rising age” of autologous breast reconstruction with TRAM and DIEP flaps. The focus of clinical research changed over this time period and ranged from innovations in surgical technique to analysis of clinical outcomes, comparative analyses with other reconstructive modalities, timing of reconstruction, and preoperative diagnostic workup, as well as cost-effectiveness analyses. This literature review illustrates the dramatic change that has occurred subsequent to introduction of abdominal flaps for breast reconstruction. While the use of abdominal flaps has become widely accepted for breast reconstruction, many questions remain unanswered, thus highlighting the need for ongoing clinical investigation.

Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions

“…Since its first description in 1979 [ 1 ], autologous breast reconstruction has evolved as a safe and viable option. More than that, it is now regarded as the international gold-standard in reconstructive breast surgery [ 2 , 3 ]. Breast reconstruction was revolutionized in 1989, when Koshima et al introduced perforator-based reconstruction using the deep inferior epigastric perforator (DIEP) flap [ 4 ], thus significantly reducing donor site morbidity whilst at the same time maximizing clinical outcomes and generating aesthetically pleasing results.…”

Interdisciplinary Treatment of Breast Cancer After Mastectomy With Autologous Breast Reconstruction Using Abdominal Free Flaps in a University Teaching Hospital—A Standardized and Safe Procedure

“…Although this is a retrospective single-center study, our results and the pertinent literature prove that autologous breast reconstruction, using abdominal free flaps, is a safe procedure in high-volume microsurgery centers, even following a previous radiation and regardless of patient's age (42,(56)(57)(58). Preoperative CTA visualizes abdominal wall vasculature, thereby minimizing operation time and morbidity.…”

“…Originating from the TRAM flap, equally whether the pedicled or free flap version, abdominal flaps for breast reconstruction experienced a consequent further development (3,4,42). In this regard, Koshima and Soeda (8) introduced the DIEP flap, whereas Nahabedian et al (43) popularized the muscle-sparing TRAM.…”

Intraoperative Blood Flow Analysis of DIEP vs. ms-TRAM Flap Breast Reconstruction Combining Transit-Time Flowmetry and Microvascular Indocyanine Green Angiography

“…Nowadays, abdominal tissue as the main source for breast reconstruction is preferably harvested either as a complete muscle-preserving deep inferior epigastric perforator (DIEP) flap or as a muscle-sparing transverse rectus abdominis musculocutaneous (ms-TRAM) flap [ 1 , 2 ]. The ability to reconstruct the female breast in a like-with-like fashion with low donor site morbidity has led to its widespread use [ 3 ].…”