Effect of Obesity on Flap and Donor-Site Complications in Pedicled TRAM Flap Breast Reconstruction

Abstract

The detrimental effects of obesity on pedicled and free transverse rectus abdominis myocutaneous (TRAM) flap reconstructions, including flap loss, hematoma, and donor-site hernia, are well documented. This study examined the effect of obesity on complications in patients undergoing pedicled TRAM flap breast reconstruction. A retrospective review of 224 pedicled TRAM flaps in 200 patients over a 10-year period was carried out. Patients were divided into three groups: normal weight (body mass index < 25; 47 percent of patients), overweight (body mass index 25 to 29.9; 38 percent), and obese (body mass index > or = 30; 15 percent). There were no statistically significant differences in age, smoking history, radiation/chemotherapy history, distribution of flap pedicle types, timing of reconstruction, percentage of delay procedures performed, or expanders implanted among the three subgroups. Donor-site, flap, and other miscellaneous complications were compared among subgroups, and logistic regression analysis was used to identify risk factors for flap and donor-site complications. Compared with normal weight and overweight patients, obese patients had a statistically significantly higher incidence of multiple flap complications (36.7 percent versus 10.6 percent and 36.7 percent versus 10.5 percent, respectively; p = 0.0036) and partial flap necrosis (21.6 percent versus 5.8 percent and 21.6 percent versus 7.1 percent; p = 0.01 and p = 0.03, respectively). Lastly, obese patients had a significantly higher incidence of overall (one or more) donor-site complications when compared with normal weight patients (53.3 percent versus 31.9 percent; p = 0.0499). Obese patients, in contrast to normal weight and overweight patients, have a statistically significantly higher risk for developing overall (one or more) and multiple flap complications, overall donor-site complications, TRAM flap delayed wound healing, and minor flap necrosis.