Autologous breast reconstruction is most commonly abdominally based. Healthy tissue can be harvested from a deep inferior epigastric perforator (DIEP), pedicled transverse rectus abdominis musculocutaneous (pTRAM) or free transverse rectus abdominus musculocutaneous (fTRAM) flaps. However, these flaps subject a patient to significant abdominal wall morbidity. A comparative analysis of similar DIEP, pTRAM and fTRAMflaps for breast reconstructions is necessary to better understand major risk factors for adverse outcomes.  The purpose of this study is to  determine the safety and advantages of a DIEP vs. pTRAM vs. fTRAM flaps for breast reconstruction. 

Admitted patients with either a DIEP or pTRAM or fTRAM breast flap were analyzed using the National Inpatient Sample (NIS) database from the years 2005-2014. Demographics, clinical data, and outcomes were collected. The relationship between mortality and the predictors was assessed using a stratified analysis, multivariable logistic regression model, and multivariable generalized additive model.

Patient group characteristics are presented in Table 1. The fTRAM groupmanifested the highest rate of complications and the longest HLOS. The pTRAM group had the lowest rates of complications. Table 2 summarizes the complications associated with each breast flap type. DIEP breast flaps have higher rates of hemorrhage/hematoma, thrombosis and vascular complications of other vessels, while the fTRAM group manifested the higher rate of post-operative infection and pTRAMpatients presented with the highest rate of pulmonary embolism/infarction type of complications.

Patients with autologous breast reconstruction using a fTRAM flap had the highest rate of complications overall and the longest stay in the hospital. Patients with a pTRAM flap had the lowest overall complication rate.