Autologous Breast Reconstruction with Transverse Rectus Abdominis Musculocutaneous (TRAM) or Deep Inferior Epigastric Perforator (DIEP) Flaps: An Analysis of the 100 Most Cited Articles

Abstract

Post-mastectomy autologous reconstruction with abdominal tissue has evolved over the past 4 decades and is a common reconstructive modality today. To gain more insight into this evolution, we performed an analysis of the 100 most commonly cited articles focusing on autologous breast reconstruction with transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flaps. A review of the ISI Web of Knowledge database was performed. Only peer-reviewed articles in English were included for analysis. Articles were ranked by their total citations as well as citation density (citations divided by years since publication). The 100 most cited articles were analyzed by their bibliographic parameters. The 100 most cited articles were published in 12 journals. The highest ranked plastic surgery journal published almost 2/3 of the articles. All articles were published within 23 years and marked the "rising age" of autologous breast reconstruction with TRAM and DIEP flaps. The focus of clinical research changed over this time period and ranged from innovations in surgical technique to analysis of clinical outcomes, comparative analyses with other reconstructive modalities, timing of reconstruction, and preoperative diagnostic workup, as well as cost-effectiveness analyses. This literature review illustrates the dramatic change that has occurred subsequent to introduction of abdominal flaps for breast reconstruction. While the use of abdominal flaps has become widely accepted for breast reconstruction, many questions remain unanswered, thus highlighting the need for ongoing clinical investigation.

Figure 1

The majority of the 100 most cited articles were published in journals within the field of plastic surgery. (*) Until December 2005 British Journal of Plastic Surgery, since January 2006 Journal of Plastic and Reconstructive Surgery.

Figure 2

All 100 articles in our most cited ranking were published between 1989 and 2012. The maximum number of 10 articles per year was published in 2000.

Figure 3

Cumulative citations of all 100 most cited articles were counted for each year. In 1990, 5 articles from our ranking were cited. Since then, there was an increasing trend of cumulative citations per year for all articles published until the respective year. Since the maximum of 1107 citations in 2010, there was a slight decreasing trend in the cumulative citation number.

Figure 4

All ranked articles were analyzed for authors and official institutions they were published by as labeled in the ISI Web of Knowledge. All 100 articles in our ranking are shown. USA – United States of America; UK – United Kingdom.

Figure 5

We recorded all authors from the ISI Web of Knowledge database for every article in our ranking of the most cited articles for autologous breast reconstruction. Six articles were published by 1 author. In contrast, 1 article had a maximum of 11 authors.