Patient satisfaction and aesthetic results after pedicled transverse rectus abdominis muscle flap for breast reconstruction

Background: The transverse rectus abdominis muscle (TRAM) flap is one of the most widely used procedures for breast reconstruction. Our aim was to evaluate the patient satisfaction and aesthetic results after pedicled TRAM flap. Methods: One hundred thirty-three pedicled TRAM procedures were performed between 1993 and 2000. A questionnaire was filled out by 101 patients, and they represented the study group. We investigated variables of general background, those related to the operation, and those connected with satisfaction. Results: A total of 75% of women were satisfied with the operation, 73% declared high satisfaction, and only 12% were dissatisfied with the results. A total of 86% were highly satisfied with their appearance in clothes, but only 48% were satisfied with their nude appearance. The lowest grade was given to breast sensation. A total of 82% noted high satisfaction of the spouse, compared with only 7% who stated a lack of satisfaction. Ninety percent claimed that there was no change in sexual attraction, 81% stated there was no change in sexual intercourse, and 79% noted no change in spousal attitude. Younger women reported better symmetry of breasts and a better sexual relationship with the spouse after the procedure. Women who did not undergo radiotherapy were more satisfied with all the aesthetic factors. Conclusions: Satisfaction is affected by many factors; both objective surgical factors and mental and psychological parameters vary among women. From this point of view, the pedicled TRAM flap can be considered a good option for women desiring breast reconstruction. Those who had immediate breast reconstruction were more satisfied with all measures.