A systematic review comparing the functional changes and complications of DIEP and TRAM flaps in patients receiving breast reconstruction

Abstract

Aim: Treatment for breast cancer may involve unilateral or bilateral mastectomy, with subsequent breast reconstruction surgery. Using autologous tissue flaps during reconstructive surgery is increasingly popular. The aim of this systematic review was to determine if the DIEP flap is more effective than the TRAM flap for breast reconstruction in females after a mastectomy in terms of donor site morbidity, recipient site morbidity, and functional outcome. Methods: Studies were identified using the databases Medline and Embase and applying predefined search criteria. The limits applied were; peer-reviewed, published between January 1980 to May 2013, human trials, English language. Study inclusion followed a review of the title, abstract, and full text by two independent researchers. Results: Two trends were identified. 1) DIEP flap surgery reduces the risk of abdominal weakness without increasing the risk of flap complications if performed by a surgeon well trained in microsurgery; 2) TRAM flap surgery remains a good alternative due to its evolution towards muscle-sparing techniques. Conclusion: This appears to be the first systematic review in this area of research. The evidence demonstrates that DIEP flap reduces postoperative abdominal morbidity, with no increased flap complication compared to the TRAM flap if performed by a surgeon well trained in microsurgery.