Comparison of Outcomes After Autologous Breast Reconstruction: Pedicled Extended Latissimus Dorsi Flap Versus Pedicled Transverse Rectus Abdominis Myocutaneous Flap
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Abstract
Objective: To compare the quality of life following autologous breast reconstruction using pedicled Extended Latissimus dorsi (pELD) flap versus pedicled Transverse Rectus Abdominis Myocutaneous (pTRAM) flap, including post-operative complications.
Methodology: This prospective comparative observational study was conducted at the Department of Plastic Surgery, Shifa International Hospital, Islamabad, between 18th November 2025 and 18th February 2026. A total of 40 women aged 30–70 years undergoing immediate autologous breast reconstruction were included using non-probability consecutive sampling. Of these, 18 underwent pELD reconstruction and 22 underwent pTRAM reconstruction. All patients completed the 3-month follow-up and were included in the final analysis. Data on demographic characteristics, operative parameters, and postoperative outcomes were collected. Quality of recovery was assessed using the validated Quality of Recovery-15 (QoR-15) questionnaire at baseline, Week 1, Week 4, and Week 12. Statistical analysis was performed using SPSS version 26.0 with p < 0.05 considered significant.
Results: No statistically significant differences were observed between the groups regarding operative time, hospital stay, mobilization, or QoR-15 scores at any assessment point. Seroma formation was significantly higher in the pELD group compared with the pTRAM group [7/18 (38.9%) vs 1/22 (4.5%), p = 0.018]. Both groups demonstrated an early postoperative decline in QoR-15 scores followed by gradual improvement by week 12. QoR-15 scores did not differ significantly between the two groups at baseline, week 1, week 4, or week 12.
Conclusion: Both pELD and pTRAM flaps demonstrated comparable safety profiles and postoperative quality-of-recovery outcomes. The main distinction was a higher occurrence of seroma in those who underwent pELD reconstruction. However, overall recovery patterns were similar between techniques.
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