The Deep Inferior Epigastric Perforator and Pedicled Transverse Rectus Abdominis Myocutaneous Flap in Breast Reconstruction: A Comparative Study

Abstract

BackgroundOur objective was to compare the complication rates of two common breast reconstruction techniques performed at our hospital and the cost-effectiveness for each test group.MethodsAll patients who underwent deep inferior epigastric perforator (DIEP) flap and transverse rectus abdominis myocutaneous (TRAM) flap by the same surgeon were selected and matched according to age and mastectomy with or without axillary clearance. Patients from each resultant group were selected, with the patients matched chronologically. The remainder were matched for by co-morbidities. Sixteen patients who underwent immediate breast reconstruction with pedicled TRAM flaps and 16 patients with DIEP flaps from 1999 to 2006 were accrued. The average total hospitalisation cost, length of hospitalisation, and complications in the 2 year duration after surgery for each group were compared.ResultsComplications arising from both the pedicled TRAM flaps and DIEP flaps included fat necrosis (TRAM, 3/16; DIEP, 4/16) and other minor complications (TRAM, 3/16; DIEP, 1/16). The mean hospital stay was 7.13 days (range, 4 to 12 days) for the pedicled TRAM group and 7.56 (range, 5 to 10 days) for the DIEP group. Neither the difference in complication rates nor in hospital stay duration were statistically significant. The total hospitalisation cost for the DIEP group was significantly higher than that of the pedicled TRAM group (P<0.001).ConclusionsBased on our study, the pedicled TRAM flap remains a cost-effective technique in breast reconstruction when compared to the newer, more expensive and tedious DIEP flap.

Impact of Personality Traits on Choice and Perceptions of Autologous Breast Reconstruction

“…35,36 Accordingly, the DIEP flap has been shown to cause less donor site hernias, pain scores, and to increase trunk flexion strength relative to the TRAM. 17,19,37,38 As a counter argument, the TRAM flap without a requirement of microsurgical techniques is a quicker and cheaper operation. Tan et al report an average savings of $8,865.…”

“…17 For bilateral TRAM reconstruction, the literature has clearly shown it to be associated with the greatest degree of donor site morbidity, for example, deficits in trunk extension/flexion as well as patient-reported decrease in ability to perform ADL. [17][18][19] Therefore, these data seem to suggest that bilateral PF reconstruction would somehow be more justified than unilateral reconstruction, whereby the functional deficits would not be very debilitating.…”

Multimodality Imaging of the Reconstructed Breast

“…The abdominal wall has become a popular option as a donor site for autologous breast reconstruction. TRAM flap techniques have been modified over time to decrease the morbidity associated with breast reconstruction, and several TRAM variants are available [5], including the pedicled TRAM flap (Fig. 1A) and the free deep inferior epigastric perforator (DIEP) flap (Fig.…”

Systematic review of effects of pregnancy on breast and abdominal contour after TRAM/DIEP breast reconstruction in breast cancer survivors

“…A similar procedure is undertaken in the DIEP operation using the deep inferior epigastric artery instead of the superior branch; in this procedure, the rectus muscle may be left intact. In all cases, the flap is then remodeled to look like the absent breast [12][13][14]. Muscle-sparing techniques may help in protecting lateral motor innervation to the rectus abdominis.…”