Die subjektive Wahrnehmung abdomineller Symptome nach Brustrekonstruktion mit gestielter und freier TRAM Lappenplastik

Abstract

Excellent aesthetic outcomes have been demonstrated with TRAM flap breast reconstruction. However, abdominal wall morbidity after TRAM flap breast reconstruction has not been accurately evaluated in terms of patient symptoms or patient quality of life. To further examine this issue, we performed a cross-sectional survey of TRAM flap breast reconstruction patients utilising questions from a patient-related outcome measure questionnaire. The questions were posed to post-mastectomy breast reconstruction patients. Items pertaining to abdominal wall symptoms and satisfaction with the outcome were reported on a 5-point Linkert Scale (1=very satisfied/no symptoms to 5=very dissatisfied/frequent symptoms). The study population consisted of 270 patients who underwent pedicled (n=183) or free (n=87) TRAM flap procedures. The frequency of abdominal wall symptoms reported on abdomen-specific questionnaire items was increased in the pedicled TRAM group relative to the free TRAM group. This included "tightness or pulling in abdomen" (2.34 vs. 2.01); "abdominal pain, bloating, or discomfort" (2.11 vs. 1.69); "difficulty doing everyday activities requiring the use of your abdominal muscles" (2.11 vs. 1.67); and "abdominal weakness" (2.36 vs. 1.8). We found a relatively low frequency of abdominal symptoms in the TRAM flap patients as a whole. However, there was a tendency towards increased abdominal symptoms in the pedicled TRAM patients compared to the free TRAM patients. As the population sizes in this study are somewhat limited, future studies with increased patient numbers may find greater differences between pedicled and free TRAM patients. In addition, studies evaluating the patients' abdominal wall symptoms pre- and postoperatively may allow for a detailed analysis of abdominal wall morbidity in post-mastectomy TRAM patients.