The differential effect of BMI on prosthetic versus autogenous breast reconstruction: A multivariate analysis of 12,986 patients

Hanwright, Philip J.; Davila, Armando A.; Hirsch, Elliot M.; Khan, Seema A.; Fine, Neil A.; Bilimoria, Karl Y.; Kim, John Y.S.

doi:10.1016/j.breast.2013.05.009

Cited by 84 publications

(68 citation statements)

References 38 publications

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“…22–24 Also consistent with the reported literature on autologous flap outcomes, patients with higher BMIs (≥30), had significantly greater odds for breast complications (OR=2.54, 95% CI:1.14–5.68) than patients with lower BMIs (<30). 25–27 In regard to outcomes, patients undergoing delayed breast reconstruction reported significantly lower scores for baseline satisfaction with breast, psychosocial and sexual well-being relative to similar patients undergoing immediate reconstruction (Table 3). These preoperative PRO differences in patients with delayed versus immediate breast reconstruction had dissipated at one and two years after reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes

Billig

Jagsi

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Background In women who require post-mastectomy radiation therapy, immediate autologous breast reconstruction is often discouraged. We aim to prospectively evaluate postoperative morbidity and satisfaction reported by women undergoing delayed or immediate autologous breast reconstruction in the setting of post-mastectomy radiation therapy. Methods Patients enrolled in the Mastectomy Reconstruction Outcomes Consortium Study, who received post-mastectomy radiotherapy and had immediate or delayed free abdominal-based autologous breast reconstruction were identified. Postoperative complications at one and two years after reconstruction were assessed. Patient reported outcomes were evaluated using the BREAST-Q questionnaire preoperatively, at one and two-years postoperatively. Bivariate analyses and mixed-effects regression models were used to compare outcomes. Results A total of 175 patients met our inclusion criteria. Immediate reconstructions were performed in 108 patients and delayed reconstructions in 67 patients. 93.5% of the immediate reconstructions were performed at a single center. Overall complication rates were similar based on reconstructive timing (25.9% immediate and 26.9% delayed at one year; p=0.54). Patients with delayed reconstruction reported significantly lower pre-reconstruction scores (p<0.0001) for satisfaction with breast, psychosocial and sexual well-being than did patients with immediate reconstruction. At one and two years postoperatively, both groups of patients reported comparable levels of satisfaction in assessed BREAST-Q domains. Conclusions From this prospective cohort, immediate autologous breast reconstruction in the setting of post-mastectomy radiation therapy appears to be a safe option that may be considered in select patients and centers. Breast aesthetics and quality of life, evaluated from the patient’s perspective, were not compromised by flap exposure to radiation therapy.

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Section: Discussionmentioning

confidence: 99%

Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes

Billig

Jagsi

et al. 2017

Plastic &Amp; Reconstructive Surgery

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“…This is not a novel concept in surgical literature and many previous studies have reported obesity as a significant risk factor for SSI in general. 48,49 Obesity is frequently associated with macromastia. Large preoperative breast volume results in significant dead space following mastectomy, and placement of a substantial foreign body burden (implant or TE) in the setting of already tenuous soft tissue envelope coverage can lead to infection.…”

Section: Discussionmentioning

confidence: 99%

Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

Sinha

Pusic

Wilkins

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Introduction Surgical site infection (SSI) can cause devastating reconstructive failure in implant-based breast reconstructions. Many large national database studies have offered insights into complication rates, but only capture early outcomes within 30-days post-operatively. This study evaluates both early and late SSI in immediate implant-based reconstruction and identifies predictors. Methods As part of the Mastectomy Reconstruction Outcomes Consortium Study (MROC), 1662 implant-based breast reconstructions in 1024 patients were evaluated for early vs. late SSI. Early SSI was defined as infection occurring within 30 days post-operatively and late SSI as infection occurring 31 days to 1 year. Minor infection required oral antibiotics only, and major infection required hospitalization and/or surgical treatment. Direct-to-implant (DTI) patients had one-year follow-up, and tissue-expander (TE) patients had one-year post-exchange follow-up. Results Among 1491 TE and 171 DTI reconstructions, overall SSI rate for TE was 5.7% (85/1491) after first-stage, 2.5% (31/1266) after second-stage, and 9.9% (17/171) for DTI. Over 47–71% of SSI complications occurred as late SSI. Multivariate analysis identified radiotherapy and BMI as significant predictors of late SSI. No significant difference between DTI and TE group in the occurrence of early, late, or overall SSI was found. Conclusions The majority of SSI complications in immediate implant-based breast reconstructions are late infections occurring more than 30 days following both first-stage and second-stage procedures. Radiotherapy and obesity are significantly associated with late-onset SSI. Current studies limited to early complications do not present an accurate or complete assessment of infection complications associated with implant-based breast reconstructions or their long-term clinical outcomes.

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“…It is well established that high body mass index (BMI) increases the risk for surgical complications and overall morbidity in all types of breast reconstructions, both implant-based and autologous (46)(47)(48)(49)(50)(51)(52)(53)(54). It is also well established that smoking has a negative influence on free flap breast reconstruction (6,45,(55)(56)(57)(58)(59), although some studies have failed to establish this relationship (4,(60)(61)(62).…”

Section: The Effect Of Patient Characteristics On Breast Reconstructionmentioning

confidence: 99%

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

et al. 2017

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being, health-related quality of life and satisfaction (5,7-10).Patients' satisfaction and health-related quality of life are frequently used as parameters for outcome measurement in plastic surgery. Postoperative complications after breast reconstruction are common and affect patient satisfaction.Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling. 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially.Conclusions: Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.

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The differential effect of BMI on prosthetic versus autogenous breast reconstruction: A multivariate analysis of 12,986 patients

Cited by 84 publications

References 38 publications

Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes

Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes

Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

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