Comparison of Abdominal Donor-Site Morbidity of SIEA, DIEP, and Muscle-Sparing Free TRAM Flaps for Breast Reconstruction.

A study published in September's edition of Plastic and Reconstructive Surgery examined the abdominal recovery rates and patient satisfaction after breast reconstruction with different abdominal flaps: the DIEP, SIEA and muscle-sparing free TRAM. The SIEA (superficial inferior epigastric artery) flap is the least invasive method of lower abdominal flap breast reconstruction; however, there are no published reports comparing the donor-site morbidity of SIEA flaps to that of TRAM (transverse rectus abdominis myocutaneous) flaps or DIEP (deep inferior epigastric artery perforator) flaps. A description of how these abdominal flap breast reconstruction procedures differ is available here.

The authors of the study used a 12-question patient survey and retrospective chart review to compare donor-site (abdominal) function, pain, and aesthetics in 179 patients who had unilateral or bilateral breast reconstruction with 47 SIEA flaps, 49 DIEP flaps, and 136 muscle-sparing free TRAM flaps during a 5-year period.

Unilateral SIEA flap patients scored higher on 10 of the 12 survey questions compared with unilateral muscle-sparing TRAM flap patients, including reporting significantly better postoperative lifting ability. Abdominal pain also seemed to lessen sooner in the unilateral SIEA group (though this was not statistically significant) when compared to the muscle-sparing free TRAM group. Bilateral breast reconstruction patients with at least one SIEA flap scored higher on all 12 survey questions, including reporting significantly better ability to get out of bed (sit-up motion) compared with patients with bilateral muscle-sparing TRAM or DIEP flaps. The greatest benefit of the SIEA flap occurs in cases of bilateral breast reconstruction where at least one of the flaps used is an SIEA flap. There were no differences between patients that had undergone reconstruction of only 1 breast (unilateral) with an SIEA flap versus those that had had a DIEP flap.

The authors' conclusions were that breast reconstruction using SIEA flaps results in significantly less abdominal donor-site issues than DIEP flaps in bilateral cases and free muscle-sparing TRAM flaps in both unilateral and bilateral cases. The authors felt that these differences were "clinically relevant" and recommended that SIEA flaps be used whenever possible in preference to DIEP or muscle-sparing free TRAM flaps for breast reconstruction.

These findings are not surprising to me at all. They make a lot of sense considering that the SIEA flap procedure requires the least amount of surgical dissection while the muscle-sparing free TRAM is the most invasive (due to removal of some of the rectus abdominis muscle). One would expect recovery to be easiest in patients that undergo the least invasive surgery and this is essentially what this study has shown. Interestingly though, in patients undergoing unilateral breast reconstruction (one breast only), DIEP flaps are just as good as SIEA flaps in terms of recovery and patient satisfaction even though the DIEP procedure is slightly more invasive.

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Dr Chrysopoulo is a board certified breast reconstruction surgeon specializing in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Cancer Reconstruction Blog.

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Christina Applegate Mastectomy Calls Attention To Need For Team Approach To Breast Cancer Reconstruction

Actress Christina Applegate’s public disclosure of her breast cancer, her decision to have a double mastectomy, and plans to go forth with breast reconstruction surgery, calls attention to the need for a medical “team” approach in the treatment and recovery from breast cancer.

“A decision to have breast reconstruction is a decision to have plastic surgery. And, that ought to be done by a plastic surgeon. This is what we train for and do everyday. Plastic surgeons have pioneered and refined all of the state-of-the-art techniques in breast reconstruction including implant approaches and autologous tissue (natural) transfers,” said Richard D’Amico, MD, president of the American Society of Plastic Surgeons (ASPS).

The methods for treating women with breast cancer have evolved and we are seeing scientific advancements in the treatment of this disease. These improvements can be attributed to a strong collaboration between medical specialties, in particular radiologists, pathologists, psychologists, general oncologic surgeons, medical oncologists, and plastic surgeons.

The ASPS says breast cancer patients should insist that their treatment be handled by a “team” of physicians, including plastic surgeons, with the appropriate expertise for each procedure and level of care. This, in turn, gives the breast cancer patient the best chance for positive outcomes.

“ASPS Member Surgeons are carrying out the cutting-edge research for constant outcomes improvement. Our members have the foremost training, education and experience in breast reconstruction, and should be a part of every breast care team,” said Dr. D’Amico.

Patients should not assume that anyone other than a board-certified plastic surgeon affiliated with an accredited facility is qualified to perform breast reconstruction. While technology has made breast cancer diagnosis, treatment, and reconstruction better than ever, it does not negate the need for medical expertise within each area.

According to a recent breast reconstruction study published in the Journal of Plastic and Reconstructive Surgery, 98 percent of elective mastectomy patients would have breast reconstruction again.

“That’s a success and satisfaction rate that should not be compromised,” said Dr. D’Amico.
According to ASPS statistics, more than 57,000 breast reconstruction procedures were performed in 2007.

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Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Cancer Reconstruction Blog.

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