The Impact of Obesity on Plastic Surgery Outcomes: A Systematic Review and Meta-analysis

Abstract

Background Obesity is a potential risk factor for complications in plastic surgeries. However, the data presented by primary studies are contradictory. Objectives The aim of this study was to summarize and clarify the divergences in the literature to provide a better understanding of the impact of obesity in different plastic surgery procedures. Methods We conducted a systematic review and meta-analysis of the impact of obesity on plastic surgery outcomes. Searches were conducted in MEDLINE, LILACS, SciELO, Scopus, Embase, Web of Science, Opengrey.eu, and the Cochrane Database of Systematic Reviews. The primary outcomes assessed were surgical complications, medical complications, and reoperation rates. The secondary outcome assessed was patient satisfaction. Subgroup analysis was performed to investigate the impact of each BMI category on the outcomes. Results Ninety-three articles were included in the qualitative synthesis, and 91 were used in the meta-analysis. Obese participants were 1.62 times more likely to present any of the primary outcomes (95% CI, 1.48-1.77; P < 0.00001). The highest increase in risk among plastic surgery types was observed in cosmetic procedures (risk ratio [RR], 1.80; 95% CI, 1.43-2.32; P < 0.00001). Compared with normal-weight participants, overweight participants presented a significantly increased RR for complications (RR, 1.16; 95% CI, 1.07-1.27; P = 0.0004). Most authors found no relation between BMI and overall patient satisfaction. Conclusions Obesity leads to more complications and greater incidence of reoperation compared with nonobese patients undergoing plastic surgeries. However, this effect is not evident in reconstructive surgeries in areas of the body other than the breast. Level of Evidence: 2

A Systematic Review of the Impact of Patient Factors on BREAST-Q Outcomes After Reduction Mammoplasty

“…Furthermore, breast hypertrophy and asymmetry have an increased incidence in patients with higher BMI, 28 potentially leading to greater breast-related physical concerns preoperatively. On the other hand, the positive influence of both BMI and resected weight on postoperative satisfaction with breasts is supported by evidence from the autologous breast reconstruction and body contouring literature, which report comparable postoperative satisfaction of obese patients compared with nonobese counterparts 29–31 . Most importantly, our analysis demonstrated a lack of correlation between average BMI and the average change in BREAST-Q scores across any of the QoL domains.…”

Office-based Plastic Surgery—Evidence-based Clinical and Administrative Guidelines

“…79,80,82 Instead, clinical judgment should account for the combination of procedures to be performed, procedure indication, and the overall health of the patient. 80–82…”

“…51,75,82–85 Similarly, specific to liposuction, a lipoaspirate volume less than 5 L was considered safe. 82 Two recent reviews found an increased risk of VTE in those with a lipoaspirate more than 3 L, 85 and an increased risk of VTE and other complications in those with a lipoaspirate more than 3.5 L. 86 Therefore, further postoperative monitoring can be considered for patients with a BMI more than 30 kg/m 2 , liposuction volume more than 3 L, operative time more than 4 hours, and those undergoing combined procedures. 51,85 Postoperative monitoring must be supervised by a health care provider with documentation of a course of events.…”

“…79,80,82 Instead, clinical judgment should account for the combination of procedures to be performed, procedure indication, and the overall health of the patient. [80][81][82] Procedure length is known to impact postoperative morbidity. 51 Administration of anesthesia for more than 1 hour and operations ending after 3 pm are significant, independent predictors of unanticipated admission following surgery.…”

“…Patient BMI must be considered when planning outpatient plastic surgery, as BMI is directly correlated with the risk of perioperative complications. 51,[74][75][76][77][78][79][80][81] The British National Health Service recommends patients undergoing body contouring surgery who have a BMI less than or equal to 28; however, no further clinical guidelines exist for setting BMI limits or contraindicating plastic surgery due to obesity. 79,80,82 Instead, clinical judgment should account for the combination of procedures to be performed, procedure indication, and the overall health of the patient.…”