The records of 82 women who had undergone unilateral breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap at the University of Texas M.D. Anderson Cancer Center were analyzed to determine what effect obesity had on the rate of complications and the aesthetic quality of the ultimate result. The patients were divided into four groups - thin, average, moderately obese, and markedly obese - based on a weight/height index derived by dividing the weight in kilograms by the height in meters. In the thin group (13 patients), the complication rate was only 15.4 percent. In the average group (22 patients), the complication rate was 22.7 percent. In the moderately obese group (35 patients), the complication rate was 31.4 percent. In the markedly obese group (12 patients), the rate was 41.7 percent. Aesthetic results in the abdomen tended to be better in the nonobese group, but in the breast they correlated better with the number of revisions performed than with degree of obesity. The findings in this study suggest that the complication rate of TRAM flap breast reconstruction does increase in proportion to the degree of obesity. Surgeons can therefore avoid many of the complications from TRAM flap surgery by not operating on very obese patients. Reports of complication rates from different authors may vary in part depending on their mix of obese and nonobese patients.
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