OBJECTIVE: To determine if the delay of TRAM procedure for breast reconstruction is an improved alternative for patients who suffer from obesity in comparison to patients without obesity.
METHODS: From 1995 to 2003, 107 consecutive patients who underwent a delay of TRAM were examined in a retrospective study. The delay of TRAM procedures were all performed by the senior author at a single institution. Patients were classified by their BMI (weight in kg / height in m2).
RESULTS: No patient had complete loss of her flap regardless of BMI. Patients with a BMI of 30 and under had a partial fat necrosis rate of 10 of 88 patients (11.4%). In comparison, 2 of 19 patients (10.5%) with a BMI of greater than 30 suffered from partial fat necrosis of their flap (N.S.). In fact, the patient with a BMI greater than 40 did not have any fat necrosis or flap related complication. The average BMI of the group with flap complications was 27.8 ± 4.3, while the average BMI of the group with no flap complications was 26.5 ± 4.3 (N.S.). On the other hand, non-flap related complications, such as deep vein thrombosis or pulmonary embolism, were 7.9% (7 of 88) for patients with a BMI less than 30 and 31.6% (6 of 19) for patients with a BMI greater than 30 (p=0.0112). The average BMI of the group with non-flap complications was 29.9 ± 4.9 versus 26.3 ± 4.0 for the group with no non-flap related complications (p=0.031). Of note, patients who had a history of smoking (no patients were actively smoking at the time of operation) suffered from a higher rate of flap complications although this did not reach statistical significance. Those with a history of radiation therapy had a flap complication similar to those with no history of radiation therapy.
CONCLUSION: Despite a progressively increasing overall complication rate for higher BMI patients, there was not a similar trend for flap-related complications. In fact, there was no complete flap loss or requirement of a second flap even in patients with a BMI greater than 30. Our data supports the idea that the delay of TRAM procedure is a safe and reliable technique for obese and morbidly obese patients.