Analysis of Morbidity with Unilateral vs. Bilateral Microvascular TRAM Breast Reconstruction

A greater understanding of the associated familial relationship and genetic risk of breast cancer has led oncologic surgeons to recommend prophylactic mastectomies more frequently. This places a greater demand on the reconstructive surgeon and potentially poses a greater risk to the patient. The microvascular transverse abdominis myocutaneous (TRAM) flap is frequently used in both bilateral and unilateral breast reconstruction. The purpose of this study was to compare the morbidity of unilateral vs. bilateral microvascular TRAM procedures, with the hypothesis that there is no significant difference in morbidity between the two procedures.

All patients undergoing unilateral or bilateral microvascular TRAM breast reconstruction by surgeons in the division from 1999 to 2003 were reviewed. Charts were reviewed to determine the type of reconstruction, patient's co-morbid conditions, operative impact, and postoperative course and complications, Operative impact was evaluated by comparing the length of the operative procedure, estimated blood loss, length of hospital stay, intravenous narcotic use, change in hematocrit, and the need for blood products. Complications included partial or complete flap loss, vascular compromise of the flap, fat necrosis, hematoma or seroma formation, infection, and the development of hernia or bulge at the donor site. Statistical analysis was completed.

One hundred and ten patient charts were reviewed, representing 31 bilateral and 79 unilateral reconstructions. Analysis with Student's t-test was completed. Statistically significant differences between the two groups were noted for the operative impact variables of operative duration, estimated blood loss, and transfusions received. Two complete flap losses occurred in the bilateral group, compared to zero in the unilateral group. However, this difference was not statistically significant after Fishers' exact test analysis. All other postoperative complications were not significantly different.

Despite the slight increase in operative duration, estimated blood loss, and transfusions associated with bilateral microvascular TRAM flap reconstruction, the morbidity did not increase over that of the unilateral reconstruction. Thus, bilateral autologous TRAM reconstruction is a safe and viable option for patients considering bilateral prophylactic mastectomies or simultaneous contralateral mastectomy during primary treatment for breast cancer.