Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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The Deep Inferior Epigastric Perforator and Pedicled Transverse Rectus Abdominis Myocutaneous Flap in Breast Reconstruction: A Comparative Study

  • Tan, Shane (National University Health System, National University Hospital) ;
  • Lim, Jane (Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, University of Singapore) ;
  • Yek, Jacklyn (National University Health System, National University Hospital) ;
  • Ong, Wei Chen (Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, University of Singapore) ;
  • Hing, Chor Hoong (Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, University of Singapore) ;
  • Lim, Thiam Chye (Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, University of Singapore)
  • Received : 2013.02.14
  • Accepted : 2013.04.04
  • Published : 2013.05.15
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Abstract

Background Our 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. Methods All 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. Results Complications 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). Conclusions Based 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.

Keywords

References

  1. Petit J, Rietjens M, Garusi C. Breast reconstructive techniques in cancer patients: which ones, when to apply, which immediate and long term risks? Crit Rev Oncol Hematol 2001; 38:231-9. https://doi.org/10.1016/S1040-8428(00)00137-2
  2. Tansini I. Sopra il mio nuovo processo di amputazione della mammella. Gazz Med Ital 1906;57:141.
  3. Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 1982;69:216-25. https://doi.org/10.1097/00006534-198202000-00006
  4. Saint-Cyr M, Schaverien MV, Rohrich RJ. Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg 2009;123:132e-45e. https://doi.org/10.1097/PRS.0b013e31819f2c6a
  5. Gurunluoglu R, Gurunluoglu A, Williams SA, et al. Current trends in breast reconstruction: survey of American Society of Plastic Surgeons 2010. Ann Plast Surg 2013;70:103-10. https://doi.org/10.1097/SAP.0b013e31822ed5ce
  6. Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 1999;52: 104-11. https://doi.org/10.1054/bjps.1998.3033
  7. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989;42:645-8. https://doi.org/10.1016/0007-1226(89)90075-1
  8. Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994;32:32-8. https://doi.org/10.1097/00000637-199401000-00007
  9. Seidenstuecker K, Munder B, Mahajan AL, et al. Morbidity of microsurgical breast reconstruction in patients with comorbid conditions. Plast Reconstr Surg 2011;127:1086-92. https://doi.org/10.1097/PRS.0b013e318205f255
  10. Rozen WM, Ashton MW, Taylor GI. Defining the role for autologous breast reconstruction after mastectomy: social and oncologic implications. Clin Breast Cancer 2008;8:134-42. https://doi.org/10.3816/CBC.2008.n.013
  11. Wilkins EG, Cederna PS, Lowery JC, et al. Prospective anal ysis of psychosocial outcomes in breast reconstruction: oneyear postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 2000;106: 1014-25. https://doi.org/10.1097/00006534-200010000-00010
  12. Marchac A, Bosc R, Benjoar MD, et al. A cost analysis of DIEP flap in breast reconstruction. Ann Chir Plast Esthet 2011;56:275-9. https://doi.org/10.1016/j.anplas.2011.06.001
  13. Damen TH, Wei W, Mureau MA, et al. Medium-term cost analysis of breast reconstructions in a single Dutch centre: a comparison of implants, implants preceded by tissue expansion, LD transpositions and DIEP flaps. J Plast Reconstr Aesthet Surg 2011;64:1043-53. https://doi.org/10.1016/j.bjps.2010.12.028
  14. Thoma A, Veltri K, Khuthaila D, et al. Comparison of the deep inferior epigastric perforator flap and free transverse rectus abdominis myocutaneous flap in postmastectomy reconstruction: a cost-effectiveness analysis. Plast Reconstr Surg 2004;113:1650-61. https://doi.org/10.1097/01.PRS.0000117196.61020.FD
  15. Lee SJ, Lim J, Tan WT, et al. Changes in the local morphology of the rectus abdominis muscle following the DIEP flap: an ultrasonographic study. Br J Plast Surg 2004;57:398-405. https://doi.org/10.1016/j.bjps.2003.12.014
  16. Blondeel N, Vanderstraeten GG, Monstrey SJ, et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg 1997;50:322-30. https://doi.org/10.1016/S0007-1226(97)90540-3
  17. Atisha D, Alderman AK. A systematic review of abdominal wall function following abdominal flaps for postmastectomy breast reconstruction. Ann Plast Surg 2009;63:222-30. https://doi.org/10.1097/SAP.0b013e31818c4a9e
  18. Momoh AO, Colakoglu S, Westvik TS, et al. Analysis of complications and patient satisfaction in pedicled transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flap breast reconstruction. Ann Plast Surg 2012; 69:19-23. https://doi.org/10.1097/SAP.0b013e318221b578
  19. Man LX, Selber JC, Serletti JM. Abdominal wall following free TRAM or DIEP flap reconstruction: a meta-analysis and critical review. Plast Reconstr Surg 2009;124:752-64. https://doi.org/10.1097/PRS.0b013e31818b7533
  20. Kroll SS, Sharma S, Koutz C, et al. Postoperative morphine requirements of free TRAM and DIEP flaps. Plast Reconstr Surg 2001;107:338-41. https://doi.org/10.1097/00006534-200102000-00006
  21. Kaplan JL, Allen RJ. Cost-based comparison between perforator flaps and TRAM flaps for breast reconstruction. Plast Reconstr Surg 2000;105:943-8. https://doi.org/10.1097/00006534-200003000-00017
  22. Conroy K, Malata CM. Epigastric hernia following DIEP flap breast reconstruction: complication or coincidence? J Plast Reconstr Aesthet Surg 2012;65:387-91. https://doi.org/10.1016/j.bjps.2011.07.019
  23. Yueh JH, Slavin SA, Adesiyun T, et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg 2010;125:1585-95. https://doi.org/10.1097/PRS.0b013e3181cb6351
  24. Enajat M, Smit JM, Rozen WM, et al. Aesthetic refinements and reoperative procedures following 370 consecutive DIEP and SIEA flap breast reconstructions: important considerations for patient consent. Aesthetic Plast Surg 2010;34: 306-12. https://doi.org/10.1007/s00266-009-9424-y
  25. Mizgala CL, Hartrampf CR Jr, Bennett GK. Abdominal function after pedicled TRAM flap surgery. Clin Plast Surg 1994;21:255-72.

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