Patients with a higher body mass index (BMI) may have a greater risk of overall and specific complications following autologous breast reconstruction, according to a recent study published by Barnes et al in Plastic and Reconstructive Surgery.
Background
Autologous breast reconstruction—an alternative to implant-based reconstruction following mastectomy for breast cancer—typically involves using a flap of tissue from the abdomen. The procedure offers stable breast reconstruction with fewer surgical procedures, in less time, and at lower costs compared with implant-based reconstruction. However, not all patients are optimal candidates. Risk factors for adverse outcomes include smoking, uncontrolled diabetes, and high BMI. Despite previous studies, the impact of high BMI on autologous breast reconstruction outcomes remains unclear.
Study Methods and Results
In the recent study, investigators analyzed the impact of BMI on outcomes in 365 patients who underwent microvascular autologous breast reconstruction using an abdominal-based flap in 545 breasts between 2004 and 2021. They further assessed complications among patients in three different BMI categories: normal weight (less than 25 kg/m2), overweight (25 to 29.9 kg/m2), and obesity (30 kg/m2 or higher).
The investigators discovered that several types of complications increased at distinct levels of BMI. For instance, the risk of any complication increased among those grouped into the highest BMI category of 30 kg/m2 or higher. Patients with a BMI of 35 kg/m2 or higher had an increased risk of unplanned repeat surgery, including wound breakdown requiring reoperation.
Further, the risk of infection requiring oral antibiotics increased in patients with a BMI of 25 kg/m2 or higher, whereas the risk of infections requiring intravenous antibiotics increased in those with a BMI of 30 kg/m2 or higher. Higher BMI levels were also associated with increased rates of complications related to the abdominal donor flap such as infections and wound-healing issues.
The investigators suggested optimal BMI cutoff points of 32.7 kg/m2 and 30.0 kg/m2 to minimize the incidences of any breast or abdominal complications, respectively. With a BMI of 32.7 kg/m2, the risk of breast complications was similar to the risk associated with current smoking.
Conclusions
The recent findings demonstrated a trend whereby higher BMI levels correlated with increased complication rates for patients undergoing autologous breast reconstruction. The investigators indicated that targeting specific levels of weight loss prior to the procedure might help to avoid postoperative complications.
“Our study clarifies the impact of high BMI as a risk factor for adverse outcomes of autologous breast reconstruction,” underscored senior study author Merisa Piper, MD, of the University of California, San Francisco. “By quantifying the change in risk profile associated with a given change in BMI, our results can be used clinically to set evidence-based preoperative weight loss goals for patients,” she concluded.
The investigators emphasized that more studies may be needed to evaluate the potential benefit of weight loss prior to autologous breast reconstruction.
Disclosure: For full disclosures of the study authors, visit journals.lww.com.
