Aesthetic outcomes and patient satisfaction following pedicled tram flap breast reconstruction
Main Article Content
Abstract
Breast reconstruction surgery has a positive psychological impact and improves quality of life after treatment. TRAM flap reconstruction remains the preferred choice for pedicled flap breast reconstruction. This study aims to examine long-term aesthetic results and satisfaction of patients who underwent mastectomy and immediate TRAM flap reconstruction at K Hospital. This clinical intervention study is based on 108 breast cancer patients who underwent surgery from 2018 to 2023 and had long-term follow-up. At 2-years after surgery, aesthetic results were evaluated using Duraes' 5-point scale, and patient satisfaction was assessed using the version 2.0 BREAST-Q scale. The average age was 44 year old; the excellent and very good aesthetic scores accounted for 67.6%; the average BREAST-Q satisfaction with breasts score was 72.5. In multivariate analysis, the breast aesthetic scores were significantly related to the mastectomy technique, radiotherapy indication, and breast complications. The patient satisfaction with breasts scores were significantly related to the mastectomy technique, radiotherapy indication, and breast aesthetic scores.
Article Details
Keywords
Breast reconstruction, TRAM flap, aesthetic outcome, patient satisfaction
References
2. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233-1241. doi:10.1056/NEJMoa022152
3. Jagsi R, Li Y, Morrow M, et al. Patient-reported Quality of Life and Satisfaction With Cosmetic Outcomes After Breast Conservation and Mastectomy With and Without Reconstruction: Results of a Survey of Breast Cancer Survivors. Ann Surg. 2015;261(6):1198-1206. doi:10.1097/SLA.0000000000000908
4. Broyles JM, Balk EM, Adam GP, et al. Implant-based versus Autologous Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open. 2022;10(3):e4180. doi:10.1097/GOX.0000000000004180
5. Semple JL, Viezel-Mathieu A, Alshaqsi S, et al. A Safe and Efficient Technique for Pedicled TRAM Flap Breast Reconstruction. Plast Reconstr Surg. 2023;151(6):1022e-1034e. doi:10.1097/PRS.0000000000010174
6. Duraes EFR, Schwarz GS, De Sousa JB, et al. Factors Influencing the Aesthetic Outcome and Quality of Life After Breast Reconstruction: A Cross-sectional Study. Ann Plast Surg. 2020;84(5):494-506. doi:10.1097/SAP.0000000000002157
7. Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124(2):345-353. doi:10.1097/PRS.0b013e3181aee807
8. Kuhlefelt C, Repo JP, Jahkola T, et al. Immediate versus delayed breast reconstruction: Long-term follow-up on health-related quality of life and satisfaction with breasts. J Plast Reconstr Aesthet Surg. 2024;88:478-486. doi:10.1016/j.bjps.2023.11.028
9. Tribondeau P, Soffray F. Breast reconstruction with pedicled TRAM flap (a retrospective study of 115 consecutive cases). Ann Chir Plast Esthet. 2008;53(4):309-317. doi:10.1016/j.anplas.2007.05.009
10. Moscona RA, Holander L, Or D. Patient satisfaction and aesthetic results after pedicled transverse rectus abdominis muscle flap for breast reconstruction. Ann Surg Oncol. 2006;13(12):1739-1746. doi:10.1245/s10434-006-9096-7
11. Schwitzer JA, Miller HC, Pusic AL, et al. Satisfaction following Unilateral Breast Reconstruction: A Comparison of Pedicled TRAM and Free Abdominal Flaps. Plast Reconstr Surg Glob Open. 2015;3(8):e482. doi:10.1097/GOX.0000000000000458
12. Vania R, Pranata R, Berfan A, et al. Can pedicled TRAM flap be a satisfying alternative to free TRAM in developing countries? - a systematic review and meta-analysis. Acta Chir Belg. 2020;120(6):375-382. doi:10.1080/00015458.2019.1637601
13. Li X, Wang Y. Skin- and Nipple-Areola-Sparing Mastectomy with Immediate Breast Reconstruction Using Transverse Rectus Abdominis Myocutaneous Flap and Silicone Implants in Breast Carcinoma Patients. Oncol Res Treat. 2020;43(7-8):354-361. doi:10.1159/000506841
14. Liew B, Southall C, Kanapathy M, et al. Does post-mastectomy radiation therapy worsen outcomes in immediate autologous breast flap reconstruction? A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2021;74(12):3260-3280. doi:10.1016/j.bjps.2021.08.005
15. Lee CT, Ruth K, Patel S, et al. Factors Associated with Reconstruction Failure and Major Complications After Postmastectomy Radiation to a Reconstructed Breast. Pract Radiat Oncol. 2023;13(2):122-131. doi:10.1016/j.prro.2022.09.005