A COMPARISON OF MORBIDITY FROM BILATERAL, UNIPEDICLED AND UNILATERAL,UNIPEDICLED TRAM FLAP BREAST RECONSTRUCTIONS

A large series of women who had undergone bilateral, pedicled TRAM fla p reconstructions were compared with women who had had unilateral, uni pedicled TRAM flap procedures to determine whether a bilateral TRAM fl ap breast reconstruction had significant additional morbidity. The rec ords of all women who underwent either a bilateral or unilateral pedic led TRAM flap breast reconstruction through the Emory Clinic from 1987 to 1994 (n = 257) were retrospectively analyzed with respect to gener al, breast (fat necrosis, flap loss, and cellulitis), and abdominal (h ernia, skin loss, and cellulitis) complications. By using logistic reg ression, risk factors for these complications were determined. The inc idence of fat necrosis and partial flap loss was not significantly dif ferent among bilateral patients compared with patients with unilateral TRAM reconstructions (10.0 percent versus 12.6 percent, p = 0.64 and 3.8 percent versus 5.5 percent, p = 0.74, respectively). The rate of h ernia formation in the bilateral TRAM flap patients (5.4 percent) was similar to that of unilateral patients (3.9 percent, p = 0.80). Signif icant factors for any complication in both patient populations include d obesity, smoking, and prior irradiation. The type of breast reconstr uction was not a significant factor for any breast or donor-site compl ication. A bilateral TRAM reconstruction showed a weak association wit h general complications. Review of the Emory Clinic experience with un ilateral and bilateral pedicled TRAM flap reconstuctions from 1987 to 1994 was able to detect no significant additional rate of complication s for bilateral pedicled TRAM flap breast reconstructions compared Kit h unilateral unipedicled TRAM flap procedures.