Contour Abnormalities of the Abdomen after Breast Reconstruction with Abdominal Flaps

Abstract

The purpose of the present study was to determine whether contour abnormalities of the abdomen after breast reconstruction with abdominal flaps are related to the harvest of the rectus abdominis muscle. Abdominal contour was analyzed in 155 women who had breast reconstruction with abdominal flaps; 108 women had free transverse rectus abdominis muscle (TRAM) flaps, 37 had pedicled TRAM flaps, and 10 had deep inferior epigastric perforator (DIEP) flaps. The reconstruction was unilateral in 110 women and bilateral in 45 women. Three methods of muscle-sparing were used; they are classified as preservation of the lateral muscle, preservation of the medial and lateral muscle, or preservation of the entire muscle. One of these three methods of muscle-sparing was used in 91 women (59 percent) and no muscle-sparing was used in 64 women (41 percent). Postoperative contour abnormalities occurred in 15 woman and included epigastric fullness in five, upper bulge in three, and lower bulge in 10. One woman experienced two abnormalities, one woman experienced three, and no woman developed a hernia. Of these abnormalities, 11 occurred after the free TRAM flap, seven after the pedicled TRAM flap, and none after the DIEP flap. Bilateral reconstruction resulted in 11 abnormalities in nine women, and unilateral reconstruction resulted in seven abnormalities in six women. chi2 analysis of the free and pedicled TRAM flaps demonstrates that muscle-sparing explains the observed differences in upper bulge and upper fullness (p = 0.02), with a trend toward significance for lower bulge (p = 0.06). chi2 analysis of the free TRAM and DIEP flaps does not explain the observed difference in abnormal abdominal contour. Analysis of muscle-sparing and non-muscle-sparing methods demonstrates that the observed difference between the techniques is only explained for a lower bulge after the bilateral free TRAM flap (p = 0.04).

Breast Reconstruction with the Free TRAM or DIEP Flap: Patient Selection, Choice of Flap, and Outcome

“…This has been previously demonstrated. 33,34 There does not appear to be a difference when comparing the MS-3 group to the MS-2 group. The supportive aspect of the anterior abdominal wall appears to be related primarily to the integrity of the anterior rectus sheath.…”

Choice of flaps for breast reconstruction

“…28,37,38 Studies have shown that use of this flap results in less donor-site morbidity of the abdominal wall than free or pedicled TRAM flaps. 36, 39 Ng et al observed that microsurgical techniques alone appear to show better flap perfusion and less frequent herniation and bulging in patients in whom bipedicled TRAM flaps were used than in patients who underwent flap transfer using conventional bipedicled or augmented techniques. 40 The internal mammary and axillary vessels were used simultaneously as recipient vessels for bipedicled free TRAM and bipedicled DIEP flaps.…”

The variability of the Superficial Inferior Epigastric Artery (SIEA) and its angiosome: A clinical anatomical study

“…This tissue is supplied by both superficial and deep arterial networks, which can each be used in the supply of this tissue when raised as a flap for use in free tissue transfer. There has been a shift over time to reducing the donor site morbidity in the harvest of this tissue, with sequential sparing of the rectus abdominis muscle from the transverse rectus abdominis musculocutaneous (TRAM) flap, 1,2 to the muscle-sparing TRAM flap, 3,4 and sparing of damage to the nerves innervating the remaining muscle with the use of the deep inferior epigastric artery (DIEA) perforator (DIEP) flap. [5][6][7][8] The ultimate donor-site sparing procedure is the superficial inferior epigastric artery (SIEA) flap, as it does not require any incision of the anterior rectus sheath.…”