What are possible complications from TRAM breast reconstruction?

Updated: Jul 28, 2021
  • Author: Michael R Zenn, MD, MBA, FACS; Chief Editor: James Neal Long, MD, FACS  more...
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Plastic surgeons perform the TRAM flap procedure daily and safely for many grateful patients. Because of the magnitude of the procedure, complications can occur even in the best hands. Possible complications from a TRAM flap procedure are listed below. Fortunately, major complications are uncommon. [9]

  • Fat necrosis/partial flap loss (5-15%) [10]

  • Complete loss of TRAM tissue (< 1%)

  • Umbilical necrosis (10-20%)

  • Seroma (fluid collection, usually in abdominal donor site)

  • Hematoma (bleeding at chest or abdomen)

  • Infection

  • Hernia (1-5%) [11]

  • Abdominal bulge without hernia (5-15%)

  • DVT/pulmonary embolus (< 1%)

  • Death (< 1%)

A study by Palubicka et al of 2129 patients who underwent breast surgery found that, in comparison with classic breast surgery and breast-conserving surgery, the highest incidence of surgical site infection was associated with TRAM flap breast reconstruction (8 out of 56 patients; 14.3%) and subcutaneous amputation with simultaneous reconstruction using an artificial prosthesis (30 out of 206 patients; 14.6%). [12]

A literature review by He et al indicated that in breast reconstruction, the risk of abdominal bulge/hernia is higher with pedicled TRAM flaps than with DIEP flaps (with this being most pronounced in low-volume hospitals), with the relative risk being 2.82. In addition, general satisfaction among patients was found to be lower with pedicled TRAM flaps than with DIEP flaps, but emotional well-being was reportedly comparable between the two flap types. [13]

A study by Huber et al found that in patients with breast cancer who were treated with TRAM flap breast reconstruction, the rates of hernia and infection were higher in those who underwent hormonal therapy with letrozole (13.5% and 21.6%, respectively) than in patients who received no hormonal treatment (3.9% and 7.1%, respectively). However, hormonal therapy with tamoxifen or anastrozole was not associated with a significantly different complication rate than that in controls. [14]

A study by Erdmann-Sager et al of outcomes for autologous breast reconstruction with abdominally based flaps reported that at 2-year follow-up, abdominal physical well-being was greater in patients who underwent reconstruction with DIEP or superficial inferior epigastric artery (SIEA) flaps than in those who were treated with TRAM flaps. More specifically, abdominal physical well-being scores were 7.2 and 7.8 points lower in the pedicled TRAM flap patients than in those who received DIEP or SIEA flaps, respectively, while the free TRAM flap patients had a 4.9-point lower score than did the DIEP flap group. [15]

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