How Big is Too Big: Pushing the Obesity Limits in Microsurgical Breast Reconstruction
Jamie Spitz, MD1, Perry Bradford, B.A.1, Neil Fine, MD2, Marco F. Ellis, MD3.
1University of Illinois at Chicago, Chicago, IL, USA, 2Northwestern University, Chicago, IL, USA, 3University of Illinois at Chicago, Northwestern University, Chicago, IL, USA.
PURPOSE: There have been promising results performing microvascular breast reconstruction in patients with obesity, however the definition of obesity is often poorly defined or does not extend above a body mass index (BMI) of 35. We sought to examine the perioperative outcomes in this population. METHODS: Two surgeons' experience with abdominally based microvascular breast reconstructions after mastectomy was reviewed from 2013 to 2016. Women were categorized by BMI: normal, overweight, class I, class II, and class III. Demographics comprised history of tobacco use; breast cancer diagnosis and adjuvant care; and comorbidities. Primary outcome measures included recipient and donor-site complications. Statistical analyses were performed using one-way ANOVA. RESULTS: A total of 90 women (112 breasts) underwent microsurgical breast reconstruction using abdominal tissue. Twenty-seven women (41 breasts) met criteria for class II and class III obesity. Mean follow-up was 17 months. No significant difference was found in demographics studied except BMI. No significant difference was found in flap complications among all groups, including super obese women. However, patients with BMI > 35 were associated with higher rates of reoperation for surgical correction compared to patients with BMI <35 (11.1% vs. 1.5%; p = 0.045). CONCLUSION: The surgical outcomes in patients with class II and III obesity were similar to those with a normal or overweight BMI. We modified our surgical technique in order to optimize our outcomes in the morbidly obese patient population. Based upon these preliminary findings, we were unable to determine a prohibitive BMI for performing microsurgical breast reconstruction.
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