Abdominal problems following transverse rectus abdominis myocutaneous (TRAM) and deep inferior epigastric perforators (DIEP) flaps are well recognised in these otherwise excellent methods of breast reconstruction. The authors reviewed 399 patients, of whom 57.7% had surgical complications although most of these were minor. Medical complications were not included in the survey. Of the 57% with complications, 12 patients had major surgical complications, requiring immediate return to theatre. Interestingly, a history of smoking or radiation did not appear to affect complication rates. The authors stress that preoperative counselling must include the possibility of surgical complications, even allowing that all complications had resolved at one year follow-up. In conclusion they water down this recommendation by saying that while complications may negatively affect recovery in the short-term, this MAY not be sustained long-term. Coming as it does from the USA, this is surely a defence against possible litigation, rather than a confident reassurance.

The impact of complications on function, health and satisfaction following abdominally based autologous breast reconstruction: a prospective evaluation.
Lu SM, Nelson JA, Fischer JP, et al.
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