Breast Reconstruction With Abdominal-Based Free Flaps in High Body Mass Index Population

Abstract

Obesity, which is becoming endemic in the United States, causes a significant challenge for reconstructive surgeons. This study evaluates postoperative complications and impact of weight loss in the high body mass index (BMI) population undergoing breast reconstruction with abdominal free flaps. A retrospective review of 182 consecutive patients was performed. Patients were divided into groups according to their BMI at the time of surgery (preoperative BMI) and presence of weight loss, and data were compared among groups. Multivariate analysis of effect of preoperative BMI on complications revealed that overall flap (P = 0.008) and donor (P = 0.016) complication rates were significantly higher in the obese group. Analysis of preoperative weight loss did not yield a statistically significant reduction in flap (P = 0.5161) or donor (P = 0.8034) complication rates. Univariate analysis showed that higher preoperative BMI is associated with higher risk of systemic complications (P = 0.027). It is important to inform patients preoperatively that weight loss, although beneficial for ease of procedure and quality of life, does not diminish their increased risk of complications. Body mass index during surgery is the most important predictor of complications.

Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery

“…These studies have found obese BMI to be a risk factor for numerous postoperative complications, including infection, wound disruption, and flap failure. 10-13 However, a meta-analysis performed by Shin et al 14 examined this relationship in breast and nonbreast free flap studies, concluding that this obesity-related risk is specific to breast reconstruction. While the literature is more limited for other free flap populations, obesity has not been shown to confer an increase in postoperative morbidity.…”

Effect of BMI on modality-specific outcomes in immediate breast reconstruction (IBR)—a propensity-matched analysis using the 2005-2011 ACS-NSQIP datasets

“…Obesity is a common, costly disease, and represents a major risk factor for surgical morbidity [1,3,5,8,11,12]. With the variety of reconstructive options available for breast cancer patients along with the established risk of increased obesity, it is critically important to have outcomes data to assist patients and surgeons in the decision-making process of choosing a reconstructive modality across ranges of BMI [27].…”

“…The multisystemic nature of obesity imparts added risk of surgical morbidity [6][7][8][9][10][11][12][13][14][15][16]. As such, obesity is a key predictor of surgical risk in breast surgery [11][12][13]17,18], including reconstruction, and this is directly related to progressive BMI [6,19,20].…”

The Impact of Delaying Breast Reconstruction on Patient Expectations and Health-Related Quality of Life: An Analysis Using the BREAST-Q

“…[52][53][54][55][56][57][58] As a result of a well-documented increase in complication rate, some sites have advocated for delayed reconstruction in obese patients undergoing reconstruction. 59 Thus, despite well-documented psychosocial benefits of immediate breast reconstruction, certain patients may be poor candidates. Our analysis identified numerous concerning associations between health-related quality of life and elevated BMI, including poorer preoperative satisfaction with breast, poorer preoperative psychosocial well-being, poorer preoperative physical (abdominal) well-being, and poorer preoperative sexual well-being.…”

“…Interventions aimed at improving breast reconstruction outcomes in patients with elevated BMI have shown that a decrease in preoperative BMI is associated with improved satisfaction with appearance of breasts and social appearance and may reduce the rate of complications. 59,60 In patients undergoing reconstruction despite a significantly elevated BMI, careful and considerate preoperative counseling, including a discussion of perioperative pain management, and potential complications, is essential. In patients delaying breast reconstruction as a result of elevated BMI, interdisciplinary care groups should target an improvement in quality of life.…”