In women undergoing postmastectomy breast reconstruction with their own, autologous tissue, a specific type of muscle-sparing abdominal tissue reduced complications and improved some aspects of quality of life, according to a recent study. This study compared the outcomes from reconstruction from 4 different abdominal donor sites.1

Approximately 20% of women choose autologous tissue for postmastectomy reconstruction, and the abdomen is the most common donor site. Muscle-sparing donor sites require longer surgeries and higher costs. Both pedicled and free transverse abdominis myocutaneous (TRAM) flaps incorporate the rectus muscle of the abdomen. Deep inferior epigastric artery perforator (DIEP) flaps and muscle-sparing free TRAM flaps spare the rectus muscle or use very little of it.

This study, published in Plastic and Reconstructive Surgery, examined data from 1790 women from 5 different North American centers. These women underwent reconstruction electing donor tissue from the DIEP flap (n=670), muscle-sparing free TRAM flap (n=293), free TRAM flap (n=144), or the pedicled TRAM flap (n=683). Average follow-up was 5.5 years.

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Total flap loss did not differ by flap site. In pedicled TRAM flap, partial flap loss was higher than in DIEP flap (P=.002). The death of fat cells was higher in pedicled TRAM than both DIEP and muscle-sparing free TRAM (P<.001). Pedicle TRAM also had the highest rate of hernia (P<.001).

When controlling for confounders, abdominal physical well-being scores were higher in patients who elected the DIEP flap than in patients who elected the pedicled TRAM flap.

“Complications and patient-reported outcomes differ when comparing abdominally based breast reconstruction techniques. The results of this study show that the DIEP flap was associated with the highest abdominal well-being and the lowest abdominal morbidity compared with the pedicled TRAM flap, but did not differ from muscle-sparing free TRAM and free TRAM flaps,” concluded the researchers.

Formal, randomized trials are needed to confirm these results. This study was led by Andrea Pusic, MD, Memorial Sloan Kettering Cancer Center, New York, New York.


1. Macadam SA, Zhong T, Weichman K, et al. Quality of life and patient-reported outcomes in breast cancer survivors: a multicenter comparison of four abdominally based autologous reconstruction methods. Plast Reconstr Surg. 2016;137(3):758-771. doi:10.1097/01.prs.0000479932.11170.8f.