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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
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Prepectoral Breast Reconstruction in Morbidly Obese Patients
Allen Gabriel1, Toni L Storm-Dickerson2, Vivian Chan3
1Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, Calif.
Plastic and Reconstructive Surgery. Global Open
|April 18, 2022
Summary
Prosthetic breast reconstruction using the prepectoral approach is safe for morbidly obese patients. Experienced surgeons can achieve outcomes comparable to non-obese individuals, suggesting BMI should not be a barrier.
Area of Science:
- Plastic Surgery
- Oncology
- Reconstructive Surgery
Background:
- Subpectoral prosthetic breast reconstruction in morbidly obese patients (BMI ≥40 kg/m²) is linked to increased perioperative complications.
- Immediate reconstruction in this population shows higher risks than delayed reconstruction.
- The outcomes of prepectoral breast reconstruction in morbidly obese patients remain unevaluated.
Purpose of the Study:
- To evaluate the outcomes of prepectoral breast reconstruction in morbidly obese patients.
- To compare complication rates between immediate and delayed prepectoral reconstruction in this cohort.
Main Methods:
- Retrospective review of consecutive morbidly obese patients undergoing prepectoral expander/implant reconstruction (July 2009 - April 2020).
- Data collected included demographics, comorbidities, radiotherapy, mastectomy details, and postoperative complications.
- Complications were stratified and compared based on reconstruction timing (immediate vs. delayed).
Main Results:
- 11 of 85 breasts (12.9%) in 45 patients experienced postoperative complications.
- Major complications included skin necrosis (3.5%), seroma (4.7%), wound dehiscence (5.9%), and reconstructive failure (1.2%).
- Delayed reconstruction showed a significantly higher rate of major skin necrosis (11.1%) compared to immediate reconstruction (1.5%).
Conclusions:
- Prepectoral prosthetic breast reconstruction is a viable option for morbidly obese patients.
- Outcomes can be comparable to non-obese patients when performed by experienced surgeons.
- Morbid obesity should not preclude patients from this reconstructive approach.
