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

Panayi, Adriana C.; Agha, Riaz; Sieber, Brady A.; Orgill, Dennis P.

doi:10.1055/s-0038-1627449

Cited by 101 publications

(63 citation statements)

References 77 publications

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“…In this regard, diabetes, age, BMI, and smoking are considered as risk factors for outcome after microsurgical reconstructions. [34][35][36][37][38][39] Interestingly, previous studies reviewing anastomotic patency rates and overall survival of free-tissue transfers found no significant differences in smokers when compared with nonsmokers. 9,[40][41][42] Accordingly, our study reports no significant difference in the rate of arterial or venous thrombosis between the two groups.…”

Section: Discussionmentioning

confidence: 94%

Impact of Smoking Status in Free Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: A Multicenter Study

Prantl

Moellhoff

Fritschen

et al. 2020

J Reconstr Microsurg

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Background Several patient-related factors have been identified with regard to the safety and efficacy of breast reconstructions. Using the largest database available in Europe, the presented study investigated the impact of cigarette smoking on deep inferior epigastric artery perforator (DIEP) free-flap breast reconstructions. Methods In total, 3,926 female patients underwent 4,577 free DIEP-flap breast reconstructions after malignancies in 22 different German breast cancer centers. The cases were divided into two groups: nonsmokers (NS) and smokers (S). Impact of smoking on surgical complications, controlled for covariates, and cluster effects within the cancer centers were analyzed by using generalized linear mixed models. Results Overall, there was no significant difference between the groups of patients regarding the rate of total flap loss. However, the rate of partial flap loss (0.9 vs. 3.2%, p < 0.001) and wound-healing disturbances requiring revision surgery (donor site: 1.5 vs. 4.0; recipient site: 1.3 vs. 3.6%, both p < 0.001) was significantly higher in smokers. Multivariable analysis identified smoking to be an independent risk factor for revision surgery (p = 0.001) and partial flap loss (p < 0.0001). Conclusion Our findings suggest that successful free tissue transfer can be achieved in smokers despite higher rates of partial flap losses and wound-healing disturbances. However, patients with a history of smoking requiring DIEP flap reconstruction should be critically evaluated preoperatively, informed in detail about the higher risk of complications and encouraged to quit smoking prior to surgery.

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Section: Discussionmentioning

confidence: 94%

Impact of Smoking Status in Free Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: A Multicenter Study

Prantl

Moellhoff

Fritschen

et al. 2020

J Reconstr Microsurg

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“…The rate of surgical complications was 2.3 times higher than in non-obese patients, with wound dehiscence being 2.5 times more likely in obese patients. Additionally, obese patients were 2.8 times more likely to have medical complications and have 1.9 times higher risk of reoperation [ 35 •]. Complication rates are also higher in autologous-based (flap) reconstructions in obese patients and include flap failure (both partial and complete), hematomas, necrosis, donor site infections, delayed healing of donor site, seromas, and hernias [ 36 – 39 ].…”

Section: Surgerymentioning

confidence: 99%

The Impact of Obesity on Breast Cancer Diagnosis and Treatment

et al. 2019

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Purpose of Review Obesity is a recognized risk factor for the development of breast cancer and recurrence even when patients are treated appropriately. We reviewed the literature that addresses the impact of obesity on diagnosis and the individual therapeutic interventions, and present a summary of the findings. Recent Findings Compared to non-obese women with breast cancer, obese women with breast cancer have a worse disease-free and overall survival despite appropriate local and systemic therapies. In brief, obese breast cancer patients experience more complications related to surgery, radiation, and chemotherapy. Further, obese patients are at increased risk for local recurrence compared to normal-weight women. Similarly, systemic chemotherapy is less effective, even when dosed appropriately on the basis of actual weight. Overall, endocrine therapy is less effective in obese women, and there is a suggestion that aromatase inhibitors may be selectively less effective than tamoxifen. Obese women are less likely to undergo breast reconstruction than normal-weight women, and those who do have surgery experience more surgical complications. Summary The efficacy of cancer treatments is significantly lower in obese breast cancer survivors, posing greater challenges in patient care and disease management in this patient population. Further investigations are warranted to assess the effects on treatment outcomes and optimize therapeutic mechanisms in order to successfully target breast cancer associated with obesity.

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“…Postmastectomy reconstruction in patients with Class III obesity or greater poses significant challenges to the surgeon regardless of modality. 1 , 2 These patients have higher rates of reconstructive failure with prosthetics, and their aesthetic results using an implant-based approach are typically inferior to those patients in the normal body mass index (BMI) ranges. 3 , 4 Higher rates of reconstructive failure using implants can be secondary to poorer wound healing of the mastectomy flaps, higher rates of seroma formation, and increased dead space after surgery.…”

Section: Introductionmentioning

confidence: 99%

Muscle-sparing Latissimus Dorsi: A Safe Option for Postmastectomy Reconstruction in Extremely Obese Patients

Schwartz

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Postmastectomy reconstruction in obese patients has a significant risk of complications and poor outcomes after implant-based and autologous methods. Here we present 22 consecutive patients with Class III obesity [body mass index (BMI) > 40 kg/m2] who underwent reconstruction with a muscle-sparing latissimus dorsi (MSLD) flap. Methods: A chart review of a single surgeon experience with 22 consecutive patients with Class III obesity who underwent postmastectomy reconstruction with an MSLD flap was performed. Demographics, operative details, outcomes, and complications were evaluated. Results: Twenty-two patients underwent 29 mastectomy and MSLD reconstructions. There were no flap failures. The average BMI was 47.2 kg/m2, including 12 patients with BMI > 50 kg/m2. Seven breasts demonstrated partial nipple and or mastectomy flap necrosis. There was 1 (3.4%) donor site dehiscence that healed with outpatient wound care and 1 (3.4%) seroma that required multiple aspirations in the office. The average operative times were 178 and 420 minutes for unilateral and bilateral mastectomy and immediate reconstructions, respectively. The average hospital length of stay was 0.56 and 1.3 days for unilateral and bilateral surgeries, respectively. Conclusions: These results demonstrate the utility of the MSLD flap in reconstructing the very obese. Operative times and lengths of stay compare favorably with conventional latissimus dorsi flap and abdominal-based microvascular free tissue transfer reconstructions. While our complication rates were higher than historically seen for patients with normal BMIs, there were no instances of flap failure, making this a viable reconstructive option for these very high-risk patients.

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

Cited by 101 publications

References 77 publications

Impact of Smoking Status in Free Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: A Multicenter Study

Impact of Smoking Status in Free Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: A Multicenter Study

The Impact of Obesity on Breast Cancer Diagnosis and Treatment

Muscle-sparing Latissimus Dorsi: A Safe Option for Postmastectomy Reconstruction in Extremely Obese Patients

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