Sunday, October 10, 2004

Delay of TRAM flap reconstruction of the breast in the obese patients

Howard T Wang, MD, Tristan Hartzell, BA, and Gregory S Georgiade, MD.

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.

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