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The purpose of this study was to evaluate the correlation between risk factors and hernia or bulge formation at the donor site of the transverse rectus abdominis myocutaneous (TRAM) flap. A retrospective study was conducted between September 2005 and December 2008 in 206 patients who underwent breast reconstruction with pedicled TRAM flap. Eight (3.9%) of these patients had abdominal wall hernia and 26 (12.6%) had abdominal bulging. The incidence of hernia was significantly higher (P &lt; 0.05) among patients with body mass index (BMI) &gt;/= 30 kg/m(2) (hernia incidence, 15.0%) than that among patients with BMI &lt;30 kg/m(2) (hernia incidence, 3.2%), while the incidence of abdominal bulge was significantly lower (P &lt; 0.05) among patients with BMI &gt;/= 30 kg/m(2) (abdominal bulge incidence, 5.0%) than that among patients with BMI &gt;/= 30 kg/m(2) (abdominal bulge incidence, 19.1%). Therefore, obesity was identified as a risk factor for abdominal wall hernia. It was also found that the use of mesh to reinforce the abdominal wall significantly reduced (P &lt; 0.025) the incidence of hernia (use of mesh (hernia incidence, 2.5%) versus non-mesh (hernia incidence, 5.9%)) and abdominal bulge (use of mesh (abdominal bulge incidence, 9.9%) versus non-mesh (abdominal bulge incidence, 17.3%)) among the patients.

Factors associated with hernia and bulge formation at the donor site of the pedicled TRAM flap