Introduction:  Bilateral pedicled TRAM flap breast reconstruction has recently come under increased scrutiny secondary to potential donor site morbidity, and this has led to the popularization of DIEP flap reconstruction.  This study compares post-operative abdominal donor site morbidity, functional outcome, and patient satisfaction following bilateral pedicled TRAM and bilateral DIEP flap breast reconstruction.

Methods:  105 consecutive women who underwent bilateral pedicled TRAM flap breast reconstruction between 1991 and 2007 were compared to 61 consecutive patients who underwent bilateral DIEP flap reconstruction between 2004 and 2007.  Medical records were reviewed for post-operative donor site and flap complications, as well as pertinent demographic data in both groups.  Minimum 11-month follow-up outcome data was obtained through Short Form (SF)-36, FACT-B, Michigan Breast Satisfaction, and Qualitative Assessment of Back Pain surveys.  Outcomes were compared by T-tests or Wilcoxon rank sum tests and significance was defined as p < 0.05. 

Results:  The mean follow-up interval was 6.3 years in the bilateral TRAM group and 2.3 years in the bilateral DIEP group (p < 0.001).  Demographic data between the two groups was similar except for an average age of 47.8 years in the TRAM group and 44.7 years in the DIEP group (p = 0.02).  Abdominal hernias occurred in 3 TRAM patients (2.8%) and in no DIEP patients, whereas abdominal bulges occurred in 3 TRAM (2.8%) patients and 4 DIEP patients (6.9%); however, these differences were not statistically significant.  Lower rate of fat necrosis was noted in the TRAM group compared to the DIEP group (11.4 % vs. 19.8 %, respectively, p = 0.04).  Complete flap loss occurred in one DIEP patient and none in the TRAM cohort, although this difference was not significant.  Surveys were completed by 65 TRAM patients (61.9 %) and 27 DIEP patients (44.3 %).  There was no significant difference in patient satisfaction and incidence of back pain as measured by the Michigan Breast Satisfaction and Back Pain questionnaire.  The SF-36 survey results showed no significant difference in physical function or general well-being between the two groups, but the TRAM group scored higher in the subjective energy category (67±16.7 versus 55±19.6, p = 0.01).  The FACT-B survey score was also higher in the TRAM cohort (117.8±19.0 versus 109.7±15.1, p = 0.01)

Conclusion:  Although this comparative study is limited by small sample size, preliminary results suggest no significant differences in post-operative donor site morbidity, survey based functional outcome, or patient satisfaction between bilateral TRAM flap and bilateral DIEP flap breast reconstruction.  Bilateral TRAM flap breast reconstruction, therefore, remains a good option for breast reconstruction.