POSTMASTECTOMY RECONSTRUCTION - COMPARATIVE-ANALYSIS OF THE PSYCHOSOCIAL, FUNCTIONAL, AND COSMETIC EFFECTS OF TRANSVERSE RECTUS-ABDOMINIS MUSCULOCUTANEOUS FLAP VERSUS BREAST IMPLANT RECONSTRUCTION

Over 40,000 postmastectomy breast reconstructions are performed annual ly. In this study, we investigated the psychosocial, functional, and c osmetic effects of transverse rectus abdominis musculocutaneous (TRAM) flap versus breast implant reconstruction. Thirty-three women who had undergone postmastectomy breast reconstruction were contacted by tele phone and agreed to participate in the study. Twenty-two women complet ed the self-assessment questionnaires regarding their quality of life, psychological symptoms, functional status, body image, and global sat isfaction. The TRAM and implant groups contained 8 and 14 patients, re spectively. The groups were well matched for age, employment status, m arital status, race, religion, and severity of medical and surgical il lnesses. The average follow-up was 36 months. Statistical analysis of the responses revealed that women who had undergone TRAM flap reconstr uction were more satisfied with how their reconstructed breast felt to the touch (p = .01), and them 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 functionin g at work or school, performing vigorous physical activities, particip ating in community or religious activities, visiting with relatives, a nd interacting with male friends (p < .04). There were no statisticall y significant differences in body image or overall satisfaction. In th is small cohort study, both the TRAM flap group and the implant group were satisfied with the results of their breast reconstruction, hut th e TRAM flap group was more satisfied with how their breast felt and te nded to be more satisfied with the cosmetic result. The TRAM flap grou p reported greater psychological, social, and physical impairments as a result of their reconstruction.