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Response to: Body Mass Index and Risk Stratification in Breast Augmentation
Samuel A Knoedler1,2,3, Jennifer A Watson3, Bong-Sung Kim3
1Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Background:
Body mass index (BMI) is an easily available and objective parameter for perioperative risk assessment, but its role in aesthetic breast surgery must be interpreted alongside patient-specific anatomy, implant characteristics, surgical technique, and other procedure-specific factors. We respond to comments regarding our recent analysis of BMI and early outcomes following breast augmentation.
Methods:
We contextualize the findings of our ACS-NSQIP-based study with particular attention to the limitations of BMI as a surrogate for breast anatomy, the interpretation of the identified BMI threshold, and the lack of procedure-specific and long-term outcome data within the database.
Results:
Although BMI does not capture important anatomical and technical determinants of outcome, its association with postoperative morbidity remained consistent across multivariable regression, propensity score matching, and sensitivity analyses. The identified BMI threshold should therefore be interpreted as a risk marker to support patient counseling and perioperative risk assessment rather than as a strict cutoff or contraindication to surgery. Long-term outcomes, including capsular contracture, implant malposition, revision surgery, aesthetic outcomes, and patient-reported satisfaction, remain beyond the scope of ACS-NSQIP and warrant dedicated prospective investigation.
Conclusion:
BMI represents one component of a broader, individualized approach to risk assessment in breast augmentation. Future studies integrating detailed anatomical, implant-related, surgical, and long-term patient-reported variables are needed to further refine risk stratification and shared decision-making.
Level Of Evidence V:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . (Expert opinions based on non-systematic reviews of results or mechanistic studies).
