Postmastectomy Reconstruction: Comparative Analysis of the Psychosocial, Functional, and Cosmetic Effects of Transverse Rectus Abdominis Musculocutaneous Flap Versus Breast Implant Reconstruction.

Original Articles
Annals of Plastic Surgery. 35(5):458-468, November 1995.
Cederna, Paul S. MD *; Yates, William R. MD +; Chang, Phyllis MD *; Cram, Albert E. MD *; Ricciardelli, Edward J. MD *

Abstract:
Over 40,000 postmastectomy breast reconstructions are performed annually. In this study, we investigated the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous (TRAM) flap versus breast implant reconstruction. Thirty-three women who had undergone postmastectomy breast reconstruction were contacted by telephone and agreed to participate in the study. Twenty-two women completed the self-assessment questionnaires regarding their quality of life, psychological symptoms, functional status, body image, and global satisfaction. The TRAM and implant groups contained 8 and 14 patients, respectively. The groups were well matched for age, employment status, marital status, race, religion, and severity of medical and surgical illnesses. The average follow-up was 36 months. Statistical analysis of the responses revealed that women who had undergone TRAM flap reconstruction were more satisfied with how their reconstructed breast felt to the touch (p=.01), and there was a trend toward greater satisfaction with the appearance of their reconstructed breast (p=.08). However, these same patients identified more difficulties as far as functioning at work or school, performing vigorous physical activities, participating in community or religious activities, visiting with relatives, and interacting with male friends (p.04). There were no statistically significant differences in body image or overall satisfaction. In this small cohort study, both the TRAM flap group and the implant group were satisfied with the results of their breast reconstruction, but the TRAM flap group was more satisfied with how their breast felt and tended to be more satisfied with the cosmetic result. The TRAM flap group reported greater psychological, social, and physical impairments as a result of their reconstruction.