How Big is Too Big: Pushing the Obesity Limits in Microsurgical Breast Reconstruction

Jamie A. Spitz*, Perry S. Bradford, Frank Aguilar, Sergey Y. Turin, Marco F. Ellis

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Purpose Obesity is a major public health concern in the United States, affecting nearly 79 million people. There have been promising results performing microvascular breast reconstruction in patients with obesity; however, the definition of obesity is often poorly defined or does not extend above a body mass index (BMI) of 35. Our goal was to examine outcomes of microvascular breast reconstruction in this questionably more risky population. Methods A retrospective review from 2013 to 2016 was performed of 2 surgeons' experience with abdominally based microvascular breast reconstructions. Women were categorized by BMI into the following groups: normal (18.5-24.9 kg/m2), overweight (25.1-29.0 kg/m2), class I (30.0-34.9 kg/m2), class II (35.0-39.9 kg/m2), and class III (>40 kg/m2). Demographics included history of tobacco use, breast cancer diagnosis, adjuvant care, and comorbidities. Complications evaluated included donor site (delayed wound healing, fat necrosis, dehiscence, infection, abdominal hernia/bulge, and seroma), recipient site (delayed wound healing and fat necrosis), and need for reoperation. Statistical analyses were performed using analysis of variance and χ2 test. Results A total of 90 women (117 breasts) underwent microsurgical breast reconstruction using abdominal tissue. Twenty-seven women (48 breasts) met criteria for class II and class III obesity (BMI 35-53). Mean follow-up was 24 months. No statistically significant difference was found in demographics among all groups. There was a trend toward variability in overall complications across the BMI groups (P = 0.149). Donor site complications had a significant variation across the different BMI groups (P = 0.016). The rate of donor site complications was similar in class II (8/14) and class III (7/13) obese women. Recipient site complications were similar across the BMI groups. Conclusions We found obese women to have a higher rate of abdominal donor site complications; however, this risk seems to level off at class I or II obesity. We have modified our surgical technique of managing the abdominal donor site to optimize our outcomes in the morbidly obese patient population.

Original languageEnglish (US)
Pages (from-to)137-140
Number of pages4
JournalAnnals of plastic surgery
Volume80
Issue number2
DOIs
StatePublished - Feb 1 2018

Keywords

  • autologous breast reconstruction
  • breast cancer
  • breast surgery complications
  • muscle-sparing transverse rectus abdominis myocutaneous
  • obesity
  • outcomes

ASJC Scopus subject areas

  • Surgery

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