The authors performed a retrospective cohort study of patients undergoing immediate autologous breast reconstruction with an abdominal free flap. Over a 17-month period, 625 flaps were included in 518 patients, with 40 flaps receiving irradiation. Mean patient age and BMI was 49 years and 27 kg/m2 respectively, with mean follow-up at 60 months. Fat necrosis was defined as a palpable firm region >1cm diameter lasting for >3 months. The independent predictors for fat necrosis in both groups were post-mastectomy radiation therapy, flaps with zone 3 included, at least one medical comorbidity and preoperative chemotherapy. Both muscle-sparing free TRAM and DIEP flaps exhibited significantly higher rates of fat necrosis when irradiated. However, contrary to popular belief, muscle-sparing free TRAM flaps did not have a lower rate of fat necrosis than DIEP flaps after radiotherapy. This study is limited as it is retrospective and therefore lacks details on subtypes of DIEP flap, as well as inter-surgeon variability (26 different surgeons).

Muscle-sparing TRAM flap does not protect breast reconstruction from post mastectomy radiation damage compared with the DIEP flap.
Garvey P, Clemens M, Butler C, et al.
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Neil J Cahoon

St John's Hospital, Livingston, UK.

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