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Do bilateral procedures further increase the complications for autologous breast reconstruction in obese patients?
Bulent Sacak1, Ahmet Hamdi Sakarya1, Adem Atakan Haytaoglu2,3
1Department of Plastic Aesthetic and Reconstructive Surgery, Marmara University School of Medicine, Istanbul, Turkey.
Insights
Obese patients undergoing autologous breast reconstruction have higher complication rates. However, bilateral deep inferior epigastric perforator flap procedures do not increase risks compared to unilateral ones in this group.
Area of Science:
- Plastic Surgery
- Microsurgery
- Reconstructive Surgery
Background:
- Obesity is a known risk factor for increased complications in surgical procedures.
- Autologous breast reconstruction, particularly using deep inferior epigastric perforator (DIEP) flaps, is a common procedure.
- Evaluating the impact of obesity and surgical approach on outcomes is crucial for patient safety.
Purpose of the Study:
- To assess the effect of bilateral versus unilateral breast reconstruction on complication rates in obese patients.
- To compare outcomes of autologous DIEP flap breast reconstruction between obese and non-obese patients.
- To determine if bilateral procedures pose a higher risk in obese patients undergoing breast reconstruction.
Main Methods:
- Retrospective review of medical records for patients undergoing autologous breast reconstruction between January 2017 and December 2019.
- Patients categorized into obese (BMI > 30) and non-obese (BMI < 30) groups.
- Obese group further stratified into bilateral reconstruction, unilateral reconstruction, and unilateral reconstruction with contralateral symmetrization subgroups.
Main Results:
- Obese patients (BMI > 30) experienced significantly higher rates of wound dehiscence, mastectomy skin flap necrosis, and re-operation.
- Operation time was significantly longer in the obese group.
- No significant differences in complication rates were found between obese subgroups (bilateral vs. unilateral procedures).
Conclusions:
- Microvascular breast reconstruction in obese patients is associated with increased overall complication rates.
- Bilateral DIEP flap breast reconstruction in obese patients does not significantly increase complication risks compared to unilateral procedures.
- Careful planning and execution allow for safe performance of bilateral breast reconstruction in obese patients without added risk.
Background:
Obesity is known to be associated with high complication rates. The aim of this study was to evaluate the effect of bilateral procedures on complication rates in obese patients undergoing autologous breast reconstruction with deep inferior epigastric perforator flaps.
Methods:
Medical records of patients undergoing autologous breast reconstruction between January 2017 and December 2019 were retrospectively reviewed. Patients were divided into two groups according to their body mass index (BMI): Group 1 (BMI > 30) and Group 2 (BMI < 30). Group 1 was further divided into 3 subgroups: Group 1a (bilateral reconstruction), Group 1b (unilateral reconstruction), and Group 1c (unilateral reconstruction and contralateral symmetrization). Outcomes and complication rates were compared between groups.
Results:
Ninety-one patients (with 119 free flaps) were followed up between 6 and 12 months. Length of hospital stay, smoking rates, and age were similar in all groups. Group 1 had significantly more rates of wound dehiscence (p = 0.024), mastectomy skin flap necrosis (p = 0.019), and re-operation (p = 0.033). The operation time was significantly higher in group 1 (p = 0.003). There was no significant difference between group 1 and group 2 in terms of hematoma-seroma formation, flap loss, and pulmonary thromboembolism rates. When obese subgroups were compared, no significant difference was observed in terms of complications.
Conclusion:
In our series, microvascular breast reconstruction was associated with more complication rates in obese patients. However, bilateral procedures in the obese patient group did not significantly increase risk of complications as compared to unilateral procedures. By taking appropriate measures bilateral procedures can be performed in obese patients without additional risks.
