Indices of obesity and behaviour of the pedicled tram flap in breast reconstruction.

The association between obesity and the outcome of pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps was studied in 12 patients. Obesity was assessed preoperatively by body mass index (BMI) and waist:hip circumference ratio (WHCR). The thickness of the abdominal fat and muscles was measured preoperatively with ultrasonography on the abdomen and during the nine postoperative months on the flap. Marginal or fat necrosis was more common among patients with lower body type fat distribution (WHCR less than 0.80) than in patients with medium or upper body type fat distribution. BMI and abdominal muscle and fat thicknesses were not associated with marginal or fat necrosis of the flaps. We conclude that lower body (female type) fat distribution may be associated with marginal cutaneous or fat necrosis in pedicled TRAM flaps.