Increasing body mass index increases complications but not failure rates in microvascular breast reconstruction: A...

Obesity is often considered a relative contra-indication for microvascular autologous breast reconstruction. We hypothesize that although obesity is associated with increased post-operative complications, abdominally based microvascular post mastectomy breast reconstruction can still be achieved with high rates of success. This study analyses the relationship between increasing body mass index (BMI) and post-operative complications at a high volume specialist centre, with a particular focus on serious complications.

Nine hundred and sixty patients undergoing 1460 microvascular breast reconstructions were included in the study. Obese patients (BMI ≥ 30 kg/m²) accounted for 37.7% of the cohort and were more likely to have co-morbidities, a history of smoking and bilateral reconstruction. Post-operative surgical complications occurred in 156 patients (16.3%) and medical complications occurred in 10 patients (1.0%). There was no significant difference between the flap failure rates in patients with normal BMI < 25 kg/m² (1.2% of patients, 0.9% of flaps) and obese patients (1.9% of patients, 1.2% of flaps, p = 0.07). Obesity was an independent predictor of overall complications (OR 1.7, CI 0.81-2.74, p = 0.001) but not medical complications or flap failure (OR 1.3, CI 0.43-5.8, p = 0.161 and OR 1.2, CI 0.66-6.1, p = 0.091). There was a linear relationship between increasing BMI and overall complication rates, but serious complications remained uncommon even in morbidly obese patients.

This large single-centre study demonstrates that although obesity increases the risk of overall complications, microvascular breast reconstruction can be safely and successfully achieved in the vast majority of patients. Obese patients should be carefully counselled pre-operatively, but increased BMI should not be considered a contra-indication for microvascular breast reconstruction.