Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors: A Multicenter Comparison of Four Abdominally Based Autologous Reconstruction Methods.

Abstract

BACKGROUND:

Approximately 20 percent of women select autologous tissue for postmastectomy breast reconstruction, and most commonly choose the abdomen as the donor site. An increasing proportion of women are seeking muscle-sparing procedures, but the benefit remains controversial. It is therefore important to determine whether better outcomes are associated with these techniques, thereby justifying longer operative times and increased costs.

METHODS:

Patients from five North American centers were eligible if they underwent reconstruction by means of the deep inferior epigastric artery perforator (DIEP) flap, muscle-sparing free transverse abdominis myocutaneous (TRAM) flap, free TRAM flap, or the pedicled TRAM flap. Patients were sent the BREAST-Q. Demographics and complications were collected.

RESULTS:

The authors analyzed 1790 charts representing 670 DIEP, 293 muscle-sparing free TRAM, 683 pedicled TRAM, and 144 free TRAM patients with an average follow-up of 5.5 years. Flap loss did not differ by flap type. Partial flap loss was higher in pedicled TRAM compared with DIEP (p = 0.002). Fat necrosis was higher in pedicled TRAM compared with DIEP and muscle-sparing free TRAM (p < 0.001). Hernia/bulge was highest in pedicled TRAM (p < 0.001). Physical well-being (abdomen) scores were higher in DIEP compared with pedicled TRAM controlling for confounders.

CONCLUSIONS:

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.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.

• Authors: Sheina A Macadam, Toni Zhong, Katie Weichman, Michael Papsdorf, Peter A Lennox, Alexes Hazen, Evan Matros, Joseph Disa, Babak Mehrara, Andrea L Pusic
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 137 Issue 3 Pg. 758-771 (Mar 2016) ISSN: 1529-4242 [Electronic] United States
• PMID: 26910656 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Analysis of Variance
• Breast Neoplasms (pathology, surgery)
• Chi-Square Distribution
• Cross-Sectional Studies
• Epigastric Arteries (surgery, transplantation)
• Female
• Follow-Up Studies
• Graft Rejection
• Graft Survival
• Humans
• Logistic Models
• Mammaplasty (adverse effects, methods, psychology)
• Mastectomy (methods)
• Middle Aged
• Myocutaneous Flap (blood supply, transplantation)
• Patient Outcome Assessment
• Perforator Flap (blood supply, transplantation)
• Quality of Life
• Rectus Abdominis (surgery, transplantation)
• Risk Assessment
• Self Report
• Surveys and Questionnaires
• Survivors
• Transplantation, Autologous
• Treatment Outcome
• United States