Faculty Collaboration Database

Microsurgical Breast Reconstruction in the Obese: A Better Option Than Tissue Expander/Implant Reconstruction? Plast Reconstr Surg 2019 Sep;144(3):539-546

Date

08/29/2019

Pubmed ID

31460996

DOI

10.1097/PRS.0000000000005897

Scopus ID

2-s2.0-85071652259 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

BACKGROUND: Obesity has reached epidemic proportions, with 72 million people in the United States classified as obese in 2010. This significant increase in obese patients is reflected in the breast cancer population seeking breast reconstruction. Previous studies demonstrated increased complication rates and decreased satisfaction in obese patients undergoing breast reconstruction. This study aims to directly compare prosthetic and autologous reconstruction in the obese population by evaluating surgical outcomes and patient satisfaction.

METHODS: In an institutional review board-approved study, a retrospective chart review was conducted on patients with a body mass index of 30.0 kg/m or greater who underwent breast cancer reconstruction after mastectomy with either free tissue transfer from the abdomen or prosthetic reconstruction over a 3-year period. The authors identified 96 patients with 141 reconstructions. Demographic, intraoperative, and postoperative variables were collected. All patients were sent the BREAST-Q questionnaire by means of mail to study the impact and effectiveness of breast surgery from the patient's perspective. Statistical analysis was completed with Fisher's exact test, Mantel-Haenszel chi-square test, Pearson chi square test, or Mann-Whitney-Wilcoxon test.

RESULTS: Prosthetic-based breast reconstruction was associated with increased major breast complications (p < 0.001), mastectomy skin flap necrosis (p = 0.009), infection (0.006), and overall reconstructive failure (p < 0.0001) compared with autologous reconstruction. When evaluating the results of the BREAST-Q studies, the autologous reconstruction group had improved satisfaction with breasts (p < 0.0001), satisfaction with outcome (p = 0.01), psychosocial well-being (p = 0.007), and sexual well-being (p = 0.006).

CONCLUSION: In the obese population, reconstruction with free tissue transfer from the abdomen resulted in decreased complications of the breast reconstruction site and improved patient satisfaction with outcomes compared with prosthetic reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Author List

Klement KA, Hijjawi JB, LoGiudice JA, Alghoul M, Omesiete-Adejare P

Authors

Kristen Ann Klement MD Associate Professor in the Plastic Surgery department at Medical College of Wisconsin
John A. LoGiudice MD Professor in the Plastic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Breast Neoplasms
Female
Humans
Mammaplasty
Mastectomy
Microsurgery
Middle Aged
Necrosis
Obesity
Patient Satisfaction
Retrospective Studies
Surgical Flaps