Goldilocks Mastectomy With And Without Immediate Implant-based Breast Reconstruction In Obese Patients: The Mayo Clinic Enterprise System Experience
Samyd S. Bustos, MD1, Jason Lin, BS1, Antonio J. Forte, MD, MS, PhD2, William J. Casey, III, MD3, Minh-Doan Nguyen, MD, PhD1, Nho V. Tran, MD1, Jorys Martinez-Jorge, MD1, Christin A. Harless, MD1, Judy C. Boughey, MD1, Sarah A. McLaughlin, MD2, Richard Gray, MD1, Oscar J. Manrique, MD1.
1Mayo Clinic, Rochester, MN, USA, 2Mayo Clinic, Jacksonville, FL, USA, 3Mayo Clinic, Scottsdale, AZ, USA.
PURPOSE: Obesity is a risk factor for surgical patients. Thus, implant-based breast reconstruction in obese women may be controversial. We conducted an analysis of obese patients with ptotic breasts who underwent Goldilocks mastectomy and compared outcomes between two groups: immediate implant-based reconstruction(IBR) and no IBR.
METHODS: Retrospective review from 2012-2019 at the three Mayo Clinic campuses. Patients with BMI≥30kg/m2 and ptotic breasts grade≥II who underwent skin-sparing Goldilocks mastectomy were included. Breasts with prior reduction/augmentation mammoplasty or other types of radical mastectomy were excluded. Demographics, operative characteristics, outcomes and complications were assessed. Two groups were compared: IBR vs. no IBR. Satisfaction and aesthetic outcomes were also assessed.
RESULTS: One-hundred-sixteen patients (198 breasts) were included. Mean age and BMI were 54.1±10.4years and 37.9±5.8kg/m2. Median follow-up time was 14.9months(Q1-9.8, Q3-27.7). A total of 100(50.5%)breasts underwent Goldilocks mastectomy without IBR, 92(46.5%) with two-stage IBR and 6(3.0%)one-stage IBR. In the IBR group, 87 breasts underwent prepectoral and 10 subpectoral implant placement. Univariate and multivariate analyses showed increased risk of major complications(hematoma requiring drainage, unplanned reoperations, infection requiring drainage or IV antibiotics, skin-flap full-necrosis) in the IBR group(OR2.8, 1.3-6.2). When severe obese patients(BMI≥35) were analyzed, IBR was associated with an even higher risk of major complications(OR4.8, 2.0-11.7). No difference in satisfaction or aesthetic outcomes was found among groups.
CONCLUSION: IBR is an essential component for women undergoing mastectomy. However, in obese and particularly in severely obese women, other surgical reconstructive options and further discussion are encouraged due to the significant high complication rate.
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