Microsurgical Breast Reconstruction in the Obese Patient Using Abdominal Flaps: Complication Profile and Patient...

Area of Science:

• Plastic Surgery
• Oncology
• Bariatric Medicine

Background:

• The rising prevalence of obesity presents challenges in breast reconstruction.
• Obese patients increasingly seek autologous breast reconstruction using abdominal free flaps.

Purpose of the Study:

• To compare complication rates and patient satisfaction between obese and nonobese women undergoing autologous breast reconstruction.
• To evaluate the impact of body mass index (BMI) on outcomes of microsurgical breast reconstruction.

Main Methods:

• Retrospective review of 109 patients (149 reconstructions) over 15 years, divided into obese (BMI ≥ 30 kg/m²) and nonobese groups.
• Data collected included demographics, medical history, surgical details, complications, and patient-reported outcomes via Breast-Q surveys.
• Statistical analysis compared complication rates and satisfaction scores between the two groups.

Main Results:

• Obese patients experienced higher rates of mastectomy flap necrosis (19.3% vs 7.7%) and unplanned reoperations (38.6% vs 21.1%).
• Severe wound complications requiring intervention (15.8% vs 3.8%) and abdominal bulge (10.5% vs 0%) were more frequent in the obese group.
• No significant difference in microsurgical complications or flap loss was observed; patient satisfaction (Breast-Q) was comparable between groups.

Conclusions:

• Obesity is linked to increased wound complications, reoperations, and abdominal bulges in microsurgical breast reconstruction.
• Despite higher complication risks, patient satisfaction remains high, indicating obesity should not be an absolute contraindication.
• Counseling patients on relative risks is crucial, but high BMI should not deter consideration of this reconstructive option.