Should Obesity Be Considered a Contraindication for Prepectoral Breast Reconstruction?

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Breast Reconstruction

Background:

• Prepectoral implant-based breast reconstruction is a viable option due to advances in techniques.
• Obesity is a risk factor for complications and has been considered a relative contraindication.
• Patient selection is crucial for successful outcomes in breast reconstruction.

Purpose of the Study:

• To compare outcomes of prepectoral versus subpectoral implant-based breast reconstruction in obese patients.
• To evaluate the impact of body mass index (BMI) on complication and explantation rates.

Main Methods:

• Retrospective chart review of patients with BMI ≥ 30 kg/m undergoing immediate two-stage implant-based reconstruction.
• Comparison of patient demographics, operative details, and surgical outcomes between prepectoral and subpectoral groups.
• Analysis of complication and device explantation rates in relation to BMI.

Main Results:

• Complications and explantation rates were comparable between prepectoral (6.4%) and subpectoral (8.2%) reconstruction groups (p=0.522).
• Final reconstruction success rates were high in both groups: 95.2% for prepectoral and 95.9% for subpectoral.
• Increased BMI correlated with higher odds of complications and device explantation, with optimal cutoffs around 34.8-34.1 kg/m.

Conclusions:

• Obesity does not necessitate excluding patients from prepectoral breast reconstruction.
• Complications and reconstruction rates are similar between prepectoral and subpectoral approaches in obese patients.
• Caution is advised for patients with a BMI exceeding 35 kg/m in prepectoral breast reconstruction.