Complication rate of tram flap breast reconstruction in obese patients

ABSTRACT

Transverse rectus abdominis myocutaneous [TRAM] flap is one of the common techniques used for breast reconstruction. Yet, it might carry certain risks when performed in obese patients. This study is a trial to quantify such risks. The records of 22 women with locally advanced breast cancer who had undergone unilateral breast reconstruction with the transverse rectus abdominis myocutaneous [TRAM] flap at the Department of Surgery, Alexandria University, were analyzed to determine what effect obesity had on the rate of complications. Patients were categorized into obese and non-obese according to height weight index. Ten patients were obese [group 1] and 12 were non-obese [group 2]. The overall complication rate was 41.7%. In obese patients six patients developed complications [60%] as compared to three non-obese patients [25%]. There was a trend for all forms of complications to be higher in the obese regarding wound sepsis, abdominal wall competence [bulging, hernia and pseudo-hernia], partial flap necrosis and chest infection. Ultimately most obese patients resolved these complications and obtained results that were comparable to the non-obese. The findings in this study suggest that the complication rate of TRAM flap breast reconstruction does increase with obesity; nevertheless, since the difference did not reach the level of significance, they remain acceptable candidates and should not be denied the procedure on grounds of obesity alone