Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for delayed autologous breast reconstruction using pedicled TRAM and latissimus dorsi flaps

  • Original Paper
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

The purpose of this study was to compare outcomes between patients submitted to pedicled transverse rectus abdominis musculocutaneous (pTRAM) and latissimus dorsi musculocutaneous (LD) flaps for breast reconstructions and to investigate potential risk factors for complications in autologous reconstruction.

Methods

A retrospective review of delayed autologous breast reconstructions by five surgeons in a single centre was performed. Between 2014 and 2018, 215 women underwent unilateral breast reconstruction with pTRAM or LD flaps. Patient demographics were analyzed including age, body mass index (BMI), smoking, diabetes mellitus, hypertension, radiotherapy and chemotherapy. Patient medical records were reviewed for the length of hospital stay (LOS), volume and duration of breast drainage, volume and duration of donor area drainage, major immediate complications, early and late complications, reinterventions, readmittances and reinterventions for late complications.

Results

LD reconstruction was associated with longer length of stay, duration of breast and donor area drainage and a higher prevalence of seroma in the donor area (37.8% vs 6.5%). pTRAM breast reconstruction had higher rates of pulmonary embolism and late complications. Age over 60 was a risk factor for immediate major complications. Smoking was associated with increased early complications. Late complications increased when the BMI was above 30.

Conclusions

Autologous breast reconstruction with pTRAM and LD flaps is safe and offers a long-standing pleasant aesthetic shape. The results of this study show that age over 60, BMI > 30 and smoking increase the complications rate. These patients should be informed about their higher profile risks before proceeding with the reconstruction.

Level of evidence

Level III, risk/prognostic study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of data and material

The data was collected from the digital clinical files of the patients operated in Hospital IPO Porto in January 2020.

References

  1. Erdmann-Sager J, Wilkins EG, Pusic AL, Qi J, Hamill JB, Kim HM, Guldbrandsen GE, Chun YS (2018) Complications and patient-reported outcomes after abdominal-based breast reconstruction: results of the Mastectomy Reconstruction Outcomes Consortium (MROC) study. Plast Reconstr Surg 141(2):271–281

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Tan S, Lim J, Yek J, Ong WC, Hing CH, Lim TC (2013) The deep inferior epigastric perforator and pedicled transverse rectus abdominis myocutaneous flap in breast reconstruction: a comparative study. Arch Plast Surg 40(3):187–191

    PubMed  PubMed Central  Google Scholar 

  3. Hartrampf CR, Scheflan M, Black PW (1982) Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 69(2):216–225

    CAS  PubMed  Google Scholar 

  4. Watterson PA, Bostwick J 3rd, Hester TR Jr, Bried JT, Taylor GI (1995) TRAM flap anatomy correlated with a 10-year clinical experience with 556 patients. Plast Reconstr Surg 95(7):1185–1194

    CAS  PubMed  Google Scholar 

  5. Tanzini I (1906) Sopra il mio nuovo processo di amputazione della mammella. Gaz Med Ital 57:141

    Google Scholar 

  6. Schneider WJ, Hill HL Jr, Brown RG (1977) Latissimus dorsi myocutaneous flap for breast reconstruction. Br J Plast Surg 30(4):277–281

    CAS  PubMed  Google Scholar 

  7. Bostwick J, Nahai F, Wallage JG (1979) Sixty latissimus dorsi flaps. Plast Reconstr Surg 63:31–41

    PubMed  Google Scholar 

  8. DeLong MR, Tandon VJ, Rudkin GH, Da Lio AL (2017) Latissimus dorsi flap breast reconstruction—a nationwide inpatient sample review. Ann Plast Surg 78(5):S185–S188

    CAS  PubMed  Google Scholar 

  9. Teisch LF, Gerth DJ, Tashiro J, Golpanian S, Thaller SR (2015) Latissimus dorsi flap versus pedicled transverse rectus abdominis myocutaneous breast reconstruction: outcomes. J Surg Res 199(1):274–279

    PubMed  Google Scholar 

  10. Sværdborg M, Damsgaard TE (2013) Donor-site morbidity after pedicled TRAM breast reconstruction: a comparison of two different types of mesh. Ann Plast Surg 71(5):476–480

    PubMed  Google Scholar 

  11. Perdikis G, Koonce S, Collis G, Eck D (2011) Latissimus dorsi myocutaneous flap for breast reconstruction: bad rap or good flap? Eplasty 11:e39.

  12. Ascherman JA, Seruya M, Bartsich SA (2008) Abdominal wall morbidity following unilateral and bilateral breast reconstruction with pedicled TRAM flaps: an outcomes analysis of 117 consecutive patients. Plast Reconstr Surg 121(1):1–8

    CAS  PubMed  Google Scholar 

  13. Macadam SA, Zhong T, Weichman K, Papsdorf M, Lennox PA, Hazen A, Matros E, Disa J, Mehrara B, Pusic AL, Van Laeken N (2016) Quality of life and patient-reported outcomes in breast cancer survivors: a multi-center comparison of four abdominally-based autologous reconstruction methods. Plast Reconstr Surg 137(3):758–771

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Kroll SS, Baldwin B (1992) A comparison of outcomes using three different methods of breast reconstruction. Plast Reconstr Surg 90(3):455–462

    CAS  PubMed  Google Scholar 

  15. Arikawa M, Miyamoto S, Fujiki M, Higashino T, Oshima A, Sakuraba M (2017) Comparison of donor site drainage duration and seroma rate between latissimus dorsi musculocutaneous flaps and thoracodorsal artery perforator flaps. Ann Plastic Surg 79(2):183–185

    CAS  Google Scholar 

  16. Miranda BH, Amin K, Chana JS (2014) The drain game: back drains for latissimus dorsi breast reconstruction. J Plast Reconstr Aesthet Surg 67(2):226–230

    CAS  PubMed  Google Scholar 

  17. Kim EK, Eom JS, Ahn SH, Son BH, Lee TJ (2009) Evolution of the pedicled TRAM flap: a prospective study of 500 consecutive cases by a single surgeon in Asian patients. Ann Plast Surg 63(4):378–382

    CAS  PubMed  Google Scholar 

  18. Subichin MP, Patel NV, Wagner DS (2015) Method of breast reconstruction determines venous thromboembolism risk better than current prediction models. Plast Reconstr Surg Global Open 3(5)

  19. Enajat M, Damen TH, Geenen A, Timman R, van der Hulst RR, Mureau MA (2013) Pulmonary embolism after abdominal flap breast reconstruction: prediction and prevention. Plast Reconstruct Surg 131(6):1213–1222

    CAS  Google Scholar 

  20. Shultz KJ, Don S, Mahabir RC, Verheyden CN (2016) Pulmonary function after pedicled transverse rectus abdominis musculocutaneous flap breast reconstruction. Ann Plast Surg 77(1):106–109

    CAS  PubMed  Google Scholar 

  21. De Mey A, Lejour M, Declety A, Meythiaz AM (1991) Late results and current indications of latissimus dorsi breast reconstructions. Br J Plast Surg 44(1):1–4

  22. Levine SM, Patel N, Disa JJ (2012) Outcomes of delayed abdominal-based autologous reconstruction versus latissimus dorsi flap plus implant reconstruction in previously irradiated patients. Ann Plast Surg 69(4):380–382

    CAS  PubMed  Google Scholar 

  23. Youssef MM, Pucher PH, Kennedy K, Osborne C, Graja T (2016) Use of acellular dermal matrix versus latissimus dorsi flap for breast reconstruction: clinical and patient-reported outcomes. Breast J 22(6):702–704

    PubMed  Google Scholar 

  24. Ireton JE, Kluft JA, Ascherman JÁ (2013) Unilateral and bilateral breast reconstruction with pedicled TRAM flaps: an outcomes analysis of 188 consecutive patients. Plast Reconstr Surg Global Open 1(2):1

    Google Scholar 

  25. Spear SL, Ducic I, Cuoco F, Taylor N (2007) Effect of obesity on flap and donor-site complications in pedicled TRAM flap breast reconstruction. Plast Reconstruct Surg 119(3):788–795

    CAS  Google Scholar 

  26. Miranda BH, Wilson RB, Amin K, Chana JS (2015) The drain game: abdominal drains for transverse rectus abdominis myocutaneous breast reconstruction. J Plast Reconstr Aesthet Surg 68(6):810–814

    CAS  PubMed  Google Scholar 

  27. Christensen BO, Overgaard J, Kettner LO, Damsgaard TE (2013) Long-term evaluation of postmastectomy breast reconstruction with the pedicled transverse rectus abdominis musculocutaneous flap. J Plast Surg Hand Surg 47(5):374–378

    PubMed  Google Scholar 

  28. Chun YS, Sinha I, Turko A, Lipsitz S, Pribaz JJ (2010) Outcomes and patient satisfaction following breast reconstruction with bilateral pedicled TRAM flaps in 105 consecutive patients. Plast Reconstr Surg 125(1):1–9

    CAS  PubMed  Google Scholar 

  29. Chun YS, Verma K, Sinha I, Rosen H, Hergrueter C, Wong J, Pribaz JJ (2013) Impact of prior ipsilateral chest wall radiation on pedicled TRAM flap breast reconstruction. Ann Plast Surg 171(1):16–19

    Google Scholar 

  30. Knox AD, Ho AL, Leung L, Tashakkor AY, Lennox PA, Van Laeken N, Macadam SA (2016) Comparison of outcomes following autologous breast reconstruction using the DIEP and pedicled TRAM flaps: a 12-year clinical retrospective study and literature review. Plast Reconstr Surg 138(1):16–28

    CAS  PubMed  Google Scholar 

  31. Chirappapha P, Somintara O, Lertsithichai P, Kongdan Y, Supsamutchai C, Sukpanich R (2016) Complications and oncologic outcomes of pedicled transverse rectus abdominis myocutaneous flap in breast cancer patients. Gland Surg 5(4):405–415

    PubMed  PubMed Central  Google Scholar 

  32. Lee BT, Agarwal JP, Ascherman JA, Caterson SA, Gray DD, Hollenbeck ST, Khan SA, Loeding LD, Mahabir RC, Miller AS, Perdikis G (2017) Evidence-based clinical practice guideline: autologous breast reconstruction with DIEP or pedicled TRAM abdominal flaps. Plast Reconstr Surg 140(5):651e–664e

    CAS  PubMed  Google Scholar 

  33. Tribondeau P, Soffray F (2008) Reconstruction mammaire par lambeau musculocutané unipédiculé de muscle grand droit de l’abdomen (115 cas consécutifs). In Annales de chirurgie plastique esthetique Aug 1 (Vol. 53, No. 4, pp. 309-317) Elsevier Masson

  34. Jeong W, Lee S, Kim J (2018) Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps. Breast 1(38):45–51

    Google Scholar 

  35. Padubidri AN, Yetman R, Browne E, Lucas A, Papay F, Larive B, Zins J (2001) Complications of postmastectomy breast reconstructions in smokers, ex-smokers, and nonsmokers. Plastic Reconstr Surg 107(2):342–349

    CAS  Google Scholar 

  36. Chang LD, Buncke G, Slezak S, Buncke HJ (1996) Cigarette smoking, plastic surgery, and microsurgery. J Reconstr Microsurg 12(07):467–474

    CAS  PubMed  Google Scholar 

  37. Ducic I, Spear SL, Cuoco F, Hannan C (2005) Safety and risk factors for breast reconstruction with pedicled transverse rectus abdominis musculocutaneous flaps: a 10-year analysis. Ann Plast Surg 55(6):559–564

    CAS  PubMed  Google Scholar 

  38. Spear SL, Ducic I, Cuoco F, Hannan C (2005) The effect of smoking on flap and donor-site complications in pedicled TRAM breast reconstruction. Plast Reconstr Surg 116(7):1873–1880

    CAS  PubMed  Google Scholar 

  39. Voineskos SH, Frank SG, Cordeiro PG (2015) Breast reconstruction following conservative mastectomies: predictors of complications and outcomes. Gland Surg 4(6):484

    PubMed  PubMed Central  Google Scholar 

  40. Wilkins EG, Hamill JB, Kim HM, Kim JY, Greco RJ, Qi J, Pusic AL (2018) Complications in postmastectomy breast reconstruction one-year outcomes of the mastectomy reconstruction outcomes consortium (MROC) study. Ann Surg 267(1):164–170

    PubMed  PubMed Central  Google Scholar 

  41. Mennie JC, Mohanna PN, O’Donoghue JM, Rainsbury R, Cromwell DA (2015) Donor-site hernia repair in abdominal flap breast reconstruction: a population-based cohort study of 7929 patients. Plast Reconstr Surg 136(1):1–9

    CAS  PubMed  Google Scholar 

  42. Butz DR, Lapin B, Yao K, Wang E, Song DH, Johnson D, Sisco M (2015) Advanced age is a predictor of 30-day complications after autologous but not implant-based postmastectomy breast reconstruction. Plast Reconstr Surg 135(2):253e–261e

    CAS  PubMed  Google Scholar 

  43. Song D, Slater K, Papsdorf M, Van Laeken N, Zhong T, Hazen A, Vidal D, Macadam SA (2016) Autologous breast reconstruction in women older than 65 years versus women younger than 65 years: a multi-center analysis. Ann Plast Surg 76(2):155–163

    CAS  PubMed  Google Scholar 

  44. Fischer JP, Nelson JA, Kovach SJ, Serletti JM, Wu LC, Kanchwala S (2013) Impact of obesity on outcomes in breast reconstruction: analysis of 15,937 patients from the ACS-NSQIP datasets. J Am College Surg 217(4):656–664

    Google Scholar 

  45. Hanwright PJ, Davila AA, Hirsch EM, Khan SA, Fine NA, Bilimoria KY, Kim JY (2013) The differential effect of BMI on prosthetic versus autogenous breast reconstruction: a multivariate analysis of 12,986 patients. Breast 22(5):938–945

    PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Plastic and Reconstructive Surgery Department, Centro Hospitalar Universitário Lisboa Central, Hospital São José, Rua José António Serrano, 1150-199, Lisboa, Portugal

    Luís Mata Ribeiro & Patrícia M. Costa

  2. Plastic and Reconstructive Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

    Rita P. Meireles & Irís M. Brito

  3. Plastic and Reconstructive Surgery Department, Instituto Português de Oncologia do Porto, Porto, Portugal

    Marco A. Rebelo, Rui F. Barbosa, Miguel P. Choupina, Carlos J. Pinho & Matilde P. Ribeiro

Authors
  1. Luís Mata Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rita P. Meireles
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Irís M. Brito
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patrícia M. Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marco A. Rebelo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rui F. Barbosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Miguel P. Choupina
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlos J. Pinho
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Matilde P. Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Luís Mata Ribeiro and Rita Meireles. The first draft of the manuscript was written by Luís Mata Ribeiro and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Luís Mata Ribeiro.

Ethics declarations

Conflict of interest

Luís Mata Ribeiro, Rita P. Meireles, Irís M. Brito, Patrícia M. Costa, Marco A. Rebelo, Miguel P. Choupina, Carlos J. Pinho and Matilde P. Ribeiro declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.This is an observational study. The Local Research Ethics Committee has confirmed that no ethical approval is required.  

Informed consent

Informed consent to search personal clinical data was obtained from all patients included in the study.

Patient consent

Patients signed informed consent regarding publishing their data.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mata Ribeiro, L., Meireles, R.P., Brito, I.M. et al. Risk factors for delayed autologous breast reconstruction using pedicled TRAM and latissimus dorsi flaps. Eur J Plast Surg 44, 333–344 (2021). https://doi.org/10.1007/s00238-020-01758-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00238-020-01758-1

Keywords

Search

Navigation