Metabolic Bridge Therapy before Microvascular Breast Reconstruction in Morbidly Obese Patients: A Proof-of-Concept...

Area of Science:

• Plastic Surgery
• Bariatric Surgery
• Metabolic Medicine

Background:

• Obesity is a significant risk factor for complications following autologous breast reconstruction.
• Microvascular breast reconstruction in obese patients carries a higher risk of adverse outcomes.

Purpose of the Study:

• To evaluate the impact of bariatric surgery on modulating complication risks in obese patients undergoing microvascular breast reconstruction.
• To assess the efficacy of metabolic and bariatric surgery as a 'metabolic bridge' therapy prior to breast reconstruction.

Main Methods:

• Utilized Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) databases (2017-2022).
• Analyzed data for 1026 patients with BMI >= 35 kg/m² undergoing bariatric surgery.
• Assessed changes in BMI, comorbidities, and Breast Reconstruction Risk Assessment scores pre- and post-bariatric surgery.

Main Results:

• Average BMI decreased from 44.7 kg/m² to 32.7 kg/m² one year post-surgery.
• Type 2 diabetes remission observed in 29% of patients.
• 30-day surgical complication rates reduced from 40.4% to 24.8% (P < 0.0001), an absolute risk reduction of 15%.

Conclusions:

• Bariatric surgery demonstrates potential efficacy in reducing surgical complications for obese patients undergoing microvascular breast reconstruction.
• A lower preoperative BMI achieved through bariatric intervention is associated with decreased surgical complication risk.