The Deep Inferior Epigastric Perforator and Pedicled Transverse Rectus Abdominis Myocutaneous Flap in Breast Reconstruction: A Comparative Study

Abstract

Background Our objective was to compare the complication rates of two common breastreconstruction techniques performed at our hospital and the cost-effectivenessfor each testgroup.Methods All patients who underwent deep inferior epigastric perforator (DIEP) flap andtransverse rectus abdominis myocutaneous (TRAM) flap by the same surgeon were selectedand matched according to age and mastectomy with or without axillary clearance. Patientsfrom each resultant group were selected, with the patients matched chronologically. Theremainder were matched for by co-morbidities. Sixteen patients who underwent immediatebreast reconstruction with pedicled TRAM flaps and 16 patients with DIEP flaps from 1999to 2006 were accrued. The average total hospitalisation cost, length of hospitalisation, andcomplicationsin the 2 year duration aftersurgery for each groupwere compared.Results Complications arising from both the pedicled TRAM flaps and DIEP flaps includedfat necrosis(TRAM, 3/16; DIEP, 4/16) and otherminor complications(TRAM, 3/16; DIEP, 1/16).The mean hospitalstaywas 7.13 days(range, 4 to 12 days)forthe pedicled TRAM group and7.56 (range, 5 to 10 days)fortheDIEP group.Neitherthe difference in complication rates norin hospital stay duration were statistically significant. The total hospitalisation cost for theDIEP groupwassignificantly higherthan that ofthe pedicled TRAMgroup (P< 0.001).Conclusions Based on ourstudy,the pedicled TRAM flap remains a cost-effective techniquein breastreconstructionwhen compared to the newer,more expensive and tediousDIEP flap.

Keywords

• Perforator flap
• Surgical flap
• Mammoplasty
• Complications