Complications and Patient-Reported Outcomes after Abdominal-Based Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium (MROC) Study.

Background: Abdominal flap reconstruction is the most popular form of autologous breast reconstruction. The current study compared complications and patient-reported outcomes (PROs) after pedicled transverse rectus abdominis myocutaneous (PTRAM), free TRAM (FTRAM), deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery (SIEA) flaps. Methods: Patients having abdominal-based breast reconstruction at 11 centers were prospectively evaluated for abdominal donor-site and breast complications. PROs were measured by the BREAST-Q and PROMIS surveys. Mixed-effects regression models were used to assess the effects of procedure type on outcomes. Results: 720 patients had one-year follow-up and 587 had two-year follow-up. Two years after reconstruction, SIEA compared with DIEP flap was associated with a higher rate of donor-site complications (OR=2.7, p=0.001), however SIEA reported higher BREAST-Q abdominal physical well-being scores than DIEP at one year (mean difference: 4.72, p=0.053, on a scale from 0 to 100). This difference was not significant at two years. Abdominal physical well-being scores at two year post-operatively were lower in PTRAM group by 7.2 points (p=0.006) than DIEP and by 7.8 points (p = 0.03) than SIEA, and in FTRAM group lower by 4.9 points (p = 0.04) than DIEP. Bilateral reconstruction had significantly lower abdominal physical well-being scores compared with unilateral reconstruction. Conclusions: While all abdominal-based flaps are viable breast reconstruction options, DIEP and SIEA flaps are associated with a higher abdominal physical well-being than PTRAM and FTRAM flaps. Although SIEA flaps offer the advantage of not violating the fascia, higher rates of donor-site complications may diminish patient satisfaction. (C)2017American Society of Plastic Surgeons