A two-year prospective analysis of trunk function in TRAM breast reconstructions

Background: Functional outcomes in breast reconstruction are important quality measures and aid in patients' decision-making process. To address the concerns of abdominal wall morbidity with transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions, the authors prospectively evaluated the long-term effects of postmastectomy breast reconstruction on trunk function using objective clinical measures. Methods: Using a multicenter prospective cohort design, they recruited women undergoing first-time immediate or delayed breast reconstructions from 12 centers and 23 plastic surgeons. Trunk functional data, objectively measured with Cybex machines, for patients with an expander/implant, pedicle TRAM, and free TRAM reconstructions were evaluated preoperatively and at postoperative years 1 and 2 in 183 patients. The effects of procedure type, timing, and laterality on trunk peak torque and range of motion were analyzed using linear regression. Results: At 2 years postoperatively, procedure type, timing, and laterality did not significantly affect the range of motion for trunk flexion and extension. Peak torque for trunk flexion at year 2 was significantly decreased in patients with TRAM compared with expander/implant reconstructions (p < 0.05), with a 6 to 19 percent decrease in flexion peak torque. However, no significant difference in flexion peak torque was found between patients with free and pedicle TRAM reconstructions. Conclusions: The authors found that (1) breast cancer patients with TRAM reconstructions had a less than 20 percent long-term deficit in trunk flexion peak torque and (2) there was no significant difference in trunk function between patients receiving pedicle and free TRAM reconstructions.