ABDOMINAL-WALL STRENGTH, BULGING, AND HERNIA AFTER TRAM FLAP BREAST RECONSTRUCTION

The incidence of postoperative abdominal bulge, hernia, and the abilit y to do sit-ups was reviewed in a series of 268 patients who had under gone free TRAM (FTRAM) or conventional TRAM (CTRAM) flap breast recons truction. Minimum follow-up was 6 months. Patients were divided into f our groups: unilateral FTRAM (FT1P; n = 123), double-pedicle bilateral FTRAM (FT2P; n = 45), single-pedicle CTRAM (CT1P; n = 40), and double -pedicle or bilateral CTRAM (CT2P; n = 60). The incidence of abdominal bulges (3.8 percent) and hernia (2.6 percent) was similar in the four groups. Synthetic mesh, however, was required for reinforcement of do nor site closure twice as often in the CTRAM patients. The ability to perform sit-ups was greatest in the FT1P group (63.0 percent), slightl y lower in the CT1P group (57.1 percent), still lower in the FT2P grou p (46.2 percent), and lowest in the CT2P group (27.1 percent; p = 0.00 05). Patients reconstructed with an FTRAM flap were more likely to be able to do sit-ups (58.3 percent) than were those reconstructed with a CTRAM flap (38.2 percent; p = 0.0074). Patients who had only one musc le pedicle used were more likely to be able to do sit-ups (61.7 percen t) than were those who had two muscle pedicles used (35.6 percent; p = 0.0003). We conclude that the incidence of abdominal bulge or hernia is relatively independent of the type of TRAM flap used and the number of muscle pedicles harvested. On the other hand, postoperative abdomi nal strength, as measured by the ability do sit-ups, is influenced sig nificantly by both of these factors.