Comparison of Breast Reconstruction Using Muscle-Sparing Transverse Rectus Abdominis Myocutaneous and Deep Inferior Epigastric Perforator Flaps Assessed With the BREAST-Q Questionnaire

Abstract Background Abdominal flaps are classified as MS-0 (full rectus abdominis width), MS-1 and MS-2 (partial muscle sparing), and MS-3, the deep inferior epigastric perforator (DIEP) flap. We use MS-2 for transverse rectus abdominis myocutaneous (TRAM) flaps, including only muscle between medial and lateral row perforators, referred to as muscle-sparing TRAM (ms-TRAM). DIEP flaps reduce muscle and sheath damage. However, sacrificing some perforators may increase fat necrosis and flap congestion. Objectives Few studies have used BREAST-Q to evaluate reconstruction methods. This study compares ms-TRAM and DIEP flaps using BREAST-Q module scores. Methods Patients who underwent ms-TRAM or DIEP reconstruction and were ≥1 year postoperative at routine follow-up were included. Six BREAST-Q modules (0-100 scale) were analyzed using the Mann–Whitney U-test. Abdominal physical well-being items were dichotomized (5 vs < 5 points) and analyzed with the χ2 test. Results The authors included 280 patients (194 ms-TRAM, 86 DIEP). In unilateral reconstruction, median sexual well-being was 43 (ms-TRAM) vs 52 (DIEP), favoring DIEP (P < .05). In bilateral cases, median breast satisfaction was 73 (ms-TRAM) vs 54 (DIEP), favoring ms-TRAM (P < .05). Abdominal physical well-being showed no significant difference in unilateral cases. In bilateral cases, bloating occurred in 84.6% (ms-TRAM) vs 16.7% (DIEP), significantly higher with DIEP (P < .001). Significant differences were observed in a few items only. Conclusions BREAST-Q identified limited significant differences between reconstruction techniques. Although ms-TRAM is associated with greater abdominal dysfunction, functional preservation appears sufficient for routine daily activities. Level of Evidence: 3 (Therapeutic)