Single-Pedicled, Supercharged, or Bi-Pedicled? A Multi-Institutional Outcome Comparison of Pedicled TRAM Flap for Autologous Breast Reconstruction.

Introduction: A direct comparison of outcomes among the 3 main types of pedicled TRAM-single-, supercharged, and bi-pedicled-has yet to be conducted.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database (2008-2022) was analyzed to identify female patients who underwent pedicled TRAM flap breast reconstruction. Patients were stratified by TRAM flap type, and their 30-day postoperative outcomes were compared.

Results: A total of 2022 patients (mean age: 53 ± 9.4 years; mean BMI: 29 ± 6.4 kg/m²) were included, of whom 73% (n = 1473) received single-pedicled, 16% (n = 327) supercharged, and 11% (n = 222) bi-pedicled TRAM flaps. Overall, 433 (21%) patients experienced complications, with 155 (7.7%) surgical and 190 (9.4%) medical complications. Multivariate analysis showed generally comparable outcomes among the 3 types, but bi-pedicled flaps had a higher risk of medical complications (OR: 1.6; P = .04). Smoking, higher ASA classes, and higher BMI were independently associated with the occurrence of any complication (OR: 1.74, P = .001; OR: 1.76, P < .001; OR: 1.04, P < .001), surgical complications (OR: 1.85, P = .01; OR: 1.71, P = .002; OR: 1.035, P = .002), and readmission (OR: 2.54, P < .001; OR: 1.62, P = .02; OR: 1.04, P = .002). Smoking (OR: 2.38, P < .001), higher BMI (OR: 1.03, P = .004), and hypertension (OR: 1.47, P = .02) correlated with an increased likelihood of reoperation.

Conclusion: This study revealed that outcomes after single-, supercharged, and bi-pedicled TRAM flaps are generally comparable. Yet, bi-pedicled TRAM flap reconstruction was seen to be associated with a higher risk of medical complications. Smoking, obesity, higher ASA class, and hypertension were identified as risk factors for adverse events.