The impact of obesity on abdominal wall function after free autologous breast reconstruction

ABSTRACT Background: The pedicled TRAM flap has been a workhorse of autologous breast reconstruction for decades. However, there has been a rising concern about the abdominal wall donor site morbidity with the use of conventional TRAM flap. This has generally been cited as one of the main reasons for resorting to “abdominal wall friendly” techniques. This study has been undertaken to assess the abdominal wall function in patients with pedicled TRAM flap breast reconstruction. The entire width of the muscle and the overlying wide disk of anterior rectus sheath were harvested with the TRAM flap in all our patients and the anterior rectus sheath defect was repaired by a Proline mesh. Materials and Methods: Abdominal wall function was studied in 21 patients who underwent simultaneous primary unipedicled TRAM flap reconstruction after mastectomy for cancer. In all the patients, the abdominal wall defect was repaired using wide sheet of Proline mesh both as inlay and onlay. The assessment tools included straight and rotational curl ups and a subjective questionnaire. The abdominal wall was also examined for any asymmetry, bulge, or hernia. The minimal follow-up was 6 months postoperative. The objective results were compared with normal unoperated volunteers. Results and Conclusions: The harvesting the TRAM flap certainly results in changes to the anterior abdominal wall that can express themselves to a variable degree. A relatively high incidence of asymptomatic asymmetry of the abdomen was seen. There was total absence of hernia in our series even after a mean follow-up period of 15.5 months. A few patients were only able to partially initiate the sit up movement and suffered an important loss of strength. In most patients, synergists took over the functional movement but as the load increased, flexion and rotation performances decreased. The lack of correlation between exercise tests and the results of the questionnaire suggests that this statistically significant impairment was functionally not important. The patients encountered little or no difficulty in theis day-to-day activities. Our modification of use of a wide mesh as inlay and onlay repair minimizes the donor site morbidity. This also avoids maneuvers meant for primary closure of the rectus sheath defects, which can result in distortion of umbilicus. Therefore, in conclusion, the unipedicled TRAM flap should be regarded as a valuable option in breast reconstruction provided careful repair of the abdominal wall defect is undertaken using Proline mesh.

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Assessment of the abdominal wall function after pedicled TRAM flap surgery for breast reconstruction: Use of modified mesh repair for the donor defect

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.73430 ◽

2010 ◽

Vol 43 (2) ◽

pp. 166 ◽

Cited By ~ 4

Author(s):

RameshKumar Sharma ◽

Gurpreet Singh ◽

Chacko Cyriac

Keyword(s):

Breast Reconstruction ◽

Abdominal Wall ◽

Mesh Repair ◽

Tram Flap ◽

Wall Function ◽

Flap Surgery ◽

Abdominal Wall Function ◽

Donor Defect

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RETRACTED: Patient Satisfaction and Abdominal Wall Function: TRAM versus DIEP Flap Breast Reconstruction

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2012.02.035 ◽

2012 ◽

Vol 38 (5) ◽

pp. 420

Author(s):

John Miles ◽

Adeel Bajwa ◽

Phillip Polson ◽

Collen Muberekwa

Keyword(s):

Patient Satisfaction ◽

Breast Reconstruction ◽

Abdominal Wall ◽

Diep Flap ◽

Wall Function ◽

Abdominal Wall Function

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Retraction notice to P3: Patient satisfaction and abdominal wall function: TRAM versus DIEP flap breast reconstruction [Eur. J. Surg. Oncol. 38 (2012) 420]

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2012.07.118 ◽

2012 ◽

Vol 38 (11) ◽

pp. 1143

Author(s):

J. Miles ◽

A. Bajwa ◽

P. Polson ◽

C. Muberekwa

Keyword(s):

Patient Satisfaction ◽

Breast Reconstruction ◽

Abdominal Wall ◽

Diep Flap ◽

Wall Function ◽

Retraction Notice ◽

Abdominal Wall Function

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How Does Autologous Breast Reconstruction Impact Downtime?

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1641711 ◽

2018 ◽

Vol 34 (07) ◽

pp. 530-536 ◽

Cited By ~ 3

Author(s):

Daniel Rais ◽

Jian Farhadi ◽

Giovanni Zoccali

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Diep Flap ◽

Autologous Reconstruction ◽

Autologous Breast Reconstruction ◽

Superior Gluteal Artery ◽

Free Flap Surgery ◽

Recovery Times ◽

Time Required ◽

The Impact

Background Although autologous breast reconstruction is technically quite demanding, it offers the best outcomes in terms of durable results, patient perceptions, and postoperative pain. Many studies have focused on clinical outcomes and technical aspects of such procedures, but few have addressed the impact of various flaps on patient recovery times. This particular investigation entailed an assessment of commonly used flaps, examining the periods of time required to resume daily activities. Methods Multiple choice questionnaires were administered to 121 patients after recovery from autologous reconstruction to determine the times required in returning to specific physical activities. To analyze results, the analysis of variance F-test was applied, and odds ratios (ORs) were determined. Results Among the activities surveyed, recovery time was not always a function of free-flap surgery. Additional treatments and psychological effects also contributed. Adjuvant chemotherapy increased average downtime by 2 weeks, and postoperative irradiation prolonged recovery as much as 4 weeks. Patient downtime was unrelated to flap type, ranging from 2.9 to 21.3 weeks for various activities in question. Deep inferior epigastric perforator (DIEP) flaps yielded the highest OR and transverse upper gracilis (TUG) flaps the lowest. Conclusion Compared with superior gluteal artery perforator and TUG flaps, the DIEP flap was confirmed as the gold standard in autologous breast reconstruction, conferring the shortest recovery times. All adjuvant therapies served to prolong patient recovery as well. Surgical issues, patient lifestyles, and donor-site availability are other important aspects of flap selection.

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