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

Sheina A. Macadam, Toni Zhong, Katie E. Weichman, Michael Papsdorf, Peter A. Lennox, Alexes Hazen, Evan Matros, Joseph Disa, Babak Mehrara, Andrea L. Pusic

Research output: Contribution to journalArticle

35 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)758-771
Number of pages14
JournalPlastic and Reconstructive Surgery
Volume137
Issue number3
DOIs
StatePublished - Mar 1 2016

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Epigastric Arteries
Myocutaneous Flap
Survivors
Quality of Life
Breast Neoplasms
Muscles
Perforator Flap
Mammaplasty
Abdomen
Fat Necrosis
Operative Time
Hernia
Patient Reported Outcome Measures
Demography
Tissue Donors
Morbidity
Costs and Cost Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors : A Multicenter Comparison of Four Abdominally Based Autologous Reconstruction Methods. / Macadam, Sheina A.; Zhong, Toni; Weichman, Katie E.; Papsdorf, Michael; Lennox, Peter A.; Hazen, Alexes; Matros, Evan; Disa, Joseph; Mehrara, Babak; Pusic, Andrea L.

In: Plastic and Reconstructive Surgery, Vol. 137, No. 3, 01.03.2016, p. 758-771.

Research output: Contribution to journalArticle

Macadam, Sheina A. ; Zhong, Toni ; Weichman, Katie E. ; Papsdorf, Michael ; Lennox, Peter A. ; Hazen, Alexes ; Matros, Evan ; Disa, Joseph ; Mehrara, Babak ; Pusic, Andrea L. / Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors : A Multicenter Comparison of Four Abdominally Based Autologous Reconstruction Methods. In: Plastic and Reconstructive Surgery. 2016 ; Vol. 137, No. 3. pp. 758-771.
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T2 - A Multicenter Comparison of Four Abdominally Based Autologous Reconstruction Methods

AU - Macadam, Sheina A.

AU - Zhong, Toni

AU - Weichman, Katie E.

AU - Papsdorf, Michael

AU - Lennox, Peter A.

AU - Hazen, Alexes

AU - Matros, Evan

AU - Disa, Joseph

AU - Mehrara, Babak

AU - Pusic, Andrea L.

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N2 - 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.

AB - 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.

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