Obesity is not only a causative factor for premature mortality, it has also been demonstrated to be associated with an increased postoperative complication rate. As such, it has traditionally been considered a relative contraindication to autologous breast reconstruction. The purpose of this study was to assess whether this recommendation is justified.
A retrospective study was conducted analyzing the effect of obesity on complication rate after microsurgical autologous breast reconstruction using abdominal tissue. Patients undergoing breast reconstruction between November 2006 and February 2011 were included. In contrast to prior studies, only patients meeting criteria to undergo bariatric surgery were included in the study, thus, representing a particularly high-risk subset of patients (Group 1: BMI greater 40 kg/m2; Group 2: BMI greater 35 kg/m2 with co-morbidities).
A total of 42 breast reconstructions were performed in 28 patients who met inclusion criteria. Surgical complications were seen in a total of 9 patients (p = 1.00). All complications were successfully managed conservatively and did not prolong hospitalization. No differences were seen among study groups with respect to donor-site (p = 0.57) and recipient-site complications (p = 1.00). Of note, no partial or total flap loss was seen in this study.
Obesity is associated with a relatively high risk of minor complications postoperatively. However, complications can typically be managed non-operatively and on an outpatient basis with fairly minimal patient morbidity. We believe that obesity should not be considered a relative contraindication to autologous microsurgical breast reconstruction. Patients should, however, be informed preoperatively about their higher risk of postoperative complications.
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- Epidemic obesity and type 2 diabetes in Asia.Lancet. 2006; 368: 1681-1688
- Prevalence of overweight and obesity in the United States, 1999–2004.JAMA. 2006; 295: 1549-1555
- Body-mass index and mortality in a prospective cohort of U.S. adults.N Engl J Med. 1999; 341: 1097-1105
- Mechanisms linking obesity with cardiovascular disease.Nature. 2006; 444: 875-880
- ABC of obesity. Obesity and cancer.BMJ. 2006; 333: 1109-1111
- Minireview: obesity and breast cancer: the estrogen connection.Endocrinology. 2009; 150: 2537-2542
- Postoperative complications in obese and nonobese patients.World J Surg. 2007; 31 (discussion 561): 556-560
- Cancer statistics.CA Cancer J Clin. 2010; 60: 277-300
- Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction.Plast Reconstr Surg. 2000; 105: 1640-1648
- Complications of TRAM flap breast reconstruction in obese patients.Plast Reconstr Surg. 1989; 84: 886-892
- Effect of obesity on flap and donor-site complications in pedicled TRAM flap breast reconstruction.Plast Reconstr Surg. 2007; 119: 788-795
- Factors associated with hernia and bulge formation at the donor site of the pedicled TRAM flap.Eur J Plast Surg. 2010; 33: 203-208
- Supercharging the transverse rectus abdominis musculocutaneous flap: breast reconstruction for the overweight and obese population.Ann Plast Surg. 2008; 60: 609-613
- A case of intraoperative venous congestion of the entire DIEP-flap–a novel salvage technique and review of the literature.Microsurgery. 2010; 30: 443-446
- Abdominal wall strength: a matched-pair analysis comparing muscle-sparing TRAM flap donor-site morbidity with the effects of Abdominoplasty.Plast Reconstr Surg. 2010; 126: 1454-1459
- Comparison of donor-site morbidity of SIEA, DIEP, and muscle-sparing TRAM flaps for breast reconstruction.Plast Reconstr Surg. 2008; 122: 702-709
- A head-to-head comparison between the muscle-sparing free TRAM and the SIEA flaps: is the rate of flap loss worth the gain in abdominal wall function?.Plast Reconstr Surg. 2008; 122: 348-355
- The midabdominal TRAM flap for breast reconstruction in morbidly obese patients.Plast Reconstr Surg. 2005; 115: 764-770
- Consensus statement. Gastrointestinal surgery for severe obesity.1991 (pp. 1–20)
- The transverse abdominal island flap: part I. Indications, contraindications, results, and complications.Ann Plast Surg. 1983; 10: 24-35
- Free versus the pedicled TRAM flap: a cost comparison and outcome analysis.Plast Reconstr Surg. 1997; 100 (discussion 1425–1417): 1418-1424
- Morbidity of microsurgical breast reconstruction in patients with comorbid conditions.Plast Reconstr Surg. 2011; 127: 1086-1092
- Outcome comparison between free and pedicled TRAM flap breast reconstruction in the obese patient.Plast Reconstr Surg. 2001; 108 (discussion 1961–1952): 1954-1960
- Breast reconstruction with free tissue transfer from the abdomen in the morbidly obese.Plast Reconstr Surg. 2011; 127: 2206-2213
- Autologous breast reconstruction: the Vanderbilt experience (1998 to 2005) of independent predictors of displeasing outcomes.J Am Coll Surg. 2008; 207: 49-56
- A comparison of morbidity from bilateral, unipedicled and unilateral, unipedicled TRAM flap breast reconstructions.Plast Reconstr Surg. 1998; 101: 1819-1827
- The deep inferior epigastric perforator flap for breast reconstruction in overweight and obese patients.Plast Reconstr Surg. 2005; 115: 447-457
- Risk factors influencing transfusion rates in DIEP flap breast reconstruction.Plast Reconstr Surg. 2011; 127: 1773-1782
- The impact of obesity on patient satisfaction with breast reconstruction.Plast Reconstr Surg. 2008; 121: 1893-1899
Published online: October 24, 2011
Accepted: October 3, 2011
Received: August 24, 2011
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.