Impact of Obesity on Outcomes in Breast Reconstruction: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: The use of postmastectomy radiation therapy (PMRT) has been widely accepted for patients with 4 or more positive lymph nodes; however, its role in patients with 1-3 positive lymph nodes remains unclear. The purpose of this study is to evaluate the oncological outcomes after undergoing PMRT for breast cancer patients with a T1-2 tumors and 1-3 positive lymph nodes. METHODS: We performed a single-institution retrospective investigation that compared PMRT and outcomes in breast cancer patients with T1-2 tumors and 1-3 positive lymph nodes who underwent mastectomy from 2002 to 2015. Multivariable Cox proportional hazards regression was used to evaluate the association of PMRT with loco-regional recurrence (LRR), distant metastasis, disease-free survival, and overall survival. RESULTS: A total of 403 patients met inclusion criteria, of which 207 (51%) received PMRT while 201 (49%) did not receive PMRT after mastectomy and were followed over a median of 5.3 years. Outcomes in patients were similar by PMRT status: LRR (2 vs 0, p ¼ 0.242); distant metastasis (6 vs 7, p ¼ 0.820). After adjustment for potential confounding variables, PMRT was not associated with any cancer recurrence (hazard ratio [HR]: 1.

Long‐term complications and reconstruction failures in previously radiated breast cancer patients receiving salvage mastectomy with autologous reconstruction or tissue expander/implant‐based reconstruction

“…We also identified a significantly higher rate of reconstruction failure at 5 years with TE/I, compared to AR, for patients with overweight BMI (25.1‐30) and obese BMI (>30), but not for patients with normal BMI (≤25). It is well established in the literature that patients with current or previous smoking history and BMI ≥ 30 have a significant higher risk of failure of reconstruction . Additionally, these factors also increase the risk of infection and data have demonstrated that the most common etiology of implant‐based reconstruction failure is infection .…”

Obesity and Lower Extremity Reconstruction: Evaluating Body Mass Index as an Independent Risk Factor for Early Complications

“…6 Patients with obesity have a well-described increased risk of postoperative wound complications and hospitalacquired infections following multiple common procedures. [7][8][9][10][11][12][13] Additionally, obesity has been shown by multiple groups to be associated with increased perioperative risk in free-flap breast reconstruction, resulting in increased perioperative morbidity and higher healthcare costs. [24][25][26] However, the effect of obesity on outcomes in lower extremity reconstruction remains poorly defined with few studies evaluating its role despite widespread prevalence as a comorbidity.…”

“…4,5 The prevalence of obesity in the United States continues to grow, estimated to affect over a quarter of the working-age population. 6 This trend has significant potential healthcare implications, with obese individuals having a well-described increased risk of nosocomial infection and postoperative wound complications following multiple types of procedures, [7][8][9][10][11][12][13] as well as delayed wound healing due to pathophysiologic impairments in myofibroblast activity and collagen maturation. [14][15][16][17][18][19] While variables including advanced age and diabetes or peripheral vascular disease have been evaluated with respect to their role as a risk factor for flap failure and complications following lower extremity reconstruction, [20][21][22][23] the impact of obesity in this patient population has not been well described in the surgical literature despite its growing prevalence.…”

SWIM Flap: Skin-Sparing, Wise Pattern, Internal Mammary Perforator Breast Reconstruction

“…All 7 patients had large breasts and were at elevated risk for complications related to tissue expander reconstruction. 2 The patient was marked preoperatively while sitting upright (Fig. 1).…”