The Effects Of BMI On Reconstructive Failure Rates In Prepectoral And Subpectoral Implant-based Breast Reconstruction
Yasmina Samaha, B.S, Edward Ray, MD, Jiaxi Chen, MD, Randolph Sherman, MD.
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
PURPOSE
Implant-based breast reconstruction (IBR) surgery remains the most common reconstructive approach following mastectomy. Data is conflicting on the risk of acute complications with prepectoral and subpectoral implant placement. Identifying risk factors contributing to reconstructive failure would help inform patient selection.
METHODS
We report a single institution's IBR experience between 2007 and 2020, including cases performed by 51 plastic surgeons. For each stage of IBR, data on age, comorbidities, BMI, and acute complications were tabulated.
RESULTS
1378 patients underwent subpectoral IBR (median age = 57 years, median BMI = 24.1 kg/m2) and 264 underwent prepectoral IBR (median age = 52, median BMI = 24.2). Infection and healing complications trended higher for all prepectoral IBR (5.8% vs 4.6% for subpectoral, p > 0.05), and higher BMI patients (BMI > 24.2: 6.9% vs BMI < 24.2: 2.6% p < 0.001.) The highest rates of these complications occurred in prepectoral IBR patients with BMI > 24.2 and the lowest rates in subpectoral patients with BMI < 24.2. (7.6%, 2.5%, p = 0.01.)
CONCLUSIONS
Prepectoral IBR in high BMI patients was associated with the highest rates of infection and wound complications. Although prepectoral IBR carries a slightly higher risk of reconstructive failure than subpectoral, BMI was the most important variable predicting infection, wound complications, and reconstructive failure. BMI should be considered in the discussion of risk factors associated with different IBR techniques.
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