Background: The main theoretical advantage of a free DIEP flap is less donor site morbidity. However, whether a free DIEP flap is superior to a muscle sparing (MS) free TRAM flap, in terms of less donor site morbidity is a very difficult question to answer. One reason is because harvesting techniques can vary significantly depending on a surgeon. Another reason is the controversy regarding the methodology of evaluating the donor site abdominal function. Ultimately, the question is whether the harvesting of the flap from the abdomen has altered the patient’s life style in any ways. Are they able to engage in all their recreational and social activities they were enjoying prior to the surgery? Do they notice any pain or discomfort or disability because of the harvesting of the flap from the abdomen?
Purpose: The purpose of this study was to compare the donor-site complications and functional outcomes in women who underwent MS free TRAM flap vs. free DIEP flap breast reconstruction.
Methods: We evaluated 193 patients who had undergone either a MS free TRAM flap or a free DIEP flap for breast reconstruction between 1998-2003 by two surgeons at the MD Anderson Cancer Center. A chart review was conducted assessing for the flap type, the method of the fascia closure and postoperative donor-site complications. Donor site functional outcome was evaluated using a 14-item questionnaire.
Results: No significant difference was noted in the abdominal bulge rate between the 2 groups: 2% in unilateral MS free TRAM vs. 0% in free DIEP, 7% in bilateral MS free TRAM vs. 0% in bilateral DIEP. Based on a 60% survey response rate, no significant difference was noted in functional outcome between the MS free TRAM flap vs. free DIEP flap. This observation held true for both unilateral (p=0.15) and bilateral (p=0.16) breast reconstructions.
Conclusion: Based on our experience, there is no significant difference in the donor-site complications or functional outcome between the MS free TRAM flap and the free DIEP flap for breast reconstruction.