Wednesday, November 16, 2011

TRAM Flap and DIEP Flap Breast Reconstruction: The Latest Research on Side Effects and Complications

There are several options for breast reconstruction after a mastectomy. Some, such as the TRAM (transverse rectus abdominis myocutaneous) Flap and DIEP (deep inferior epigastric perforator) Flap procedures, use tissue from the abdomen to reconstruct the breast.

How does this affect the abdominal region? Are there any other potential complications?

A couple of recent studies and several recent news items have addressed the potential side effects and complications of TRAM Flap and DIEP Flap reconstruction. Links may be found on the TRAM Flap or DIEP Flap page of our website.

Potential abdominal side effects of TRAM Flap with muscle removal

Traditional TRAM Flap procedures remove a section of abdominal muscle. For some women, this may cause abdominal weakness and pain. On November 9, a CBS News affiliate in Minnesota published a video and story about two young mothers who suffer with abdominal pain and weakness after TRAM Flap procedures.

Dr. David Ruebeck, a plastic surgeon who was interviewed for the story, said that extreme side effects, such as those experienced by the women in the story are rare, but can happen. He noted that the benefits, such as a natural reconstruction from your own tissue and related tummy flattening, sound "really good," but have "some tradeoffs and some risks women have to be aware of."

He said it usually takes about a month to recover from a TRAM Flap procedure.

“The worst case scenario would be a situation where weakness or pain or bulging becomes a daily problem. A disability keeps a person from working or exercising the way they like of effecting posture or other comfort,” Dr. Ruebeck said. “That’s quite unusual. There’s not much that can be done about it.”
Potential abdominal side effects of muscle-sparing TRAM Flap and DIEP Flap

Whereas the original TRAM Flap procedure involves the removal of abdominal muscle, newer procedures, such as muscle-sparing TRAM Flap and the DIEP Flap surgeries attempt to spare the abdominal muscles. Even with these newer procedures, the risk of abdominal pain and weakness remains.

An October 21 study in the journal Cancer evaluated the quality of life of patients after muscle-sparing TRAM Flap and DIEP Flap procedures. Several media sources, such as US News and World Report/HealthDay, Medical News Today and the Canadian National Post covered the study.

On the positive side, the study found that gains in breast satisfaction, psychosocial and sexual well being were "clinically meaningful" as early as three weeks after surgery.

However, the authors noted that "these gains are accompanied by significant deterioration in physical well being of the abdominal donor site."

According to the National Post story, Dr. Toni Zhong, the study's lead author, "was surprised to find that even . . . in the most careful attempts to remove tissue without disturbing muscle, patients sometimes experienced muscle weakness or a bulge that persisted even three months after surgery."

She noted that the abdominal effects did not render the patients bed-ridden or inhibit everyday activities. She said, "“Some people are happy to put up with it and say it’s the price that I paid in order to have such a great breast reconstruction.” But "it can be a problem" for active women who notice the loss of muscle strength.

The study of 51 women collected satisfaction data up to three months post surgery. Dr. Zhong plans to evaluate abdominal function at six months and one year post surgery.

Tamoxifen use may cause complications in microvascular flap procedures

In a microvascular flap reconstruction, blood vessels and veins are cut and reattached using microsurgical techniques. The DIEP Flap procedure and a type of TRAM procedure called the TRAM Free Flap are microvascular procedures.

As with any surgery, microvascular flap procedures carry a risk of complications, such as ultimate flap loss.

An October 7 study from MD Anderson in Plastic and Reconstructive Surgery found that tamoxifen use "may increase the risk of microvascular flap complications." In the study, patients on tamoxifen has a "significantly increased rate of immediate total flap loss . . . and a lower rate of flap salvage. . ." The authors concluded that, "Surgeons should consider temporarily stopping the drug 28-days before microsurgical breast reconstruction."

These are only the most recent studies on TRAM Flap and DIEP Flap breast reconstruction. For two years of news and research, plus information on other reconstruction procedures, please visit our website. From the home page, click the treatments tab to explore the surgery section of our website.

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