One commonly expressed concern regarding transverse rectus abdominis myocut
aneous (TRAM) flap breast reconstruction surgery is the return of sensation
to the abdomen. Although many studies have focused on abdominal wall muscl
e incompetence or herniation, there is limited literature discussing postop
erative abdominal sensation. The purpose of this study was to assess abdomi
nal sensation a minimum of 1 year after pedicled TRAM flap surgery for brea
Twenty-five female patients who underwent TRAM flap breast reconstruction a
minimum of 1 year before the study were compared with 10 female volunteer
controls. Subject and control abdomens were specifically divided into 12 zo
nes, then assessed for superficial touch, super ficial pain, temperature, a
nd vibration using various techniques. Fischer's exact test was used for an
alysis with the p, value set at p = 0.05. The degree to which superficial t
ouch was affected was then tested using Semmes-Weinstein monofilaments. Stu
dent's t test was used for analysis with the p, value set at p = 0.05.
For all four sensory modalities, subjects were found to have decreased sens
ation in zones 5 and 8, the supraum-bilical and infraumbilical regions. Thi
s was statistically significant. When assessed with Semmes-Weinstein monofi
laments, the sensation of the subjects' abdomens was significantly decrease
d compared with controls. Significance was found in all zones.
This study clearly demonstrates that there is a significant and persistent
reduction in abdominal sensibility following TRAM flap surgery. The distrib
ution of the deficits is consistent and involves the midline supraum-bilica
l and infraumbilical regions.
The TRAM flap has become the procedure of choice for postmastectomy autogen
ous breast reconstruction. It provides the plastic surgeon with a relativel
y safe, reliable, and aesthetically pleasing method of breast reconstructio
n. Since its inception, the TRAM flap and its abdominal closure have underg
one numerous modifications designed to minimize donor-site morbidity and cr
eate a natural-looking breast. In addition to creating an aesthetically ple
asing breast, the TRAM flap has the potential advantage of postoperative im
provement in abdominal contour.