Complications of abdominal-based free flaps for breast reconstruction in obese patients: A meta-analysis and case series

Background: Obese patients now constitute a larger proportion of women seeking postmastectomy reconstruction. Achieving optimal results with a low number of complications in the obese population is challenging. This meta-analysis compares the complication risks for obese and nonobese patients receiving abdominal-based free flaps for breast reconstruction. Methods: A retrospective case series of obese and nonobese patients undergoing abdominal-based free flaps for breast reconstruction was performed and included in the meta-analysis. A literature search yielded 103 citations, and multilevel screening identified 7 relevant studies. An eight study meta-analysis, using the DerSimonian and Laird random effects models, compared pooled relative risks for complications. Results: There was a twofold risk of infection (relative risk (RR), 1.97; 95 % CI, 1.23, 3.14), two and one half times the risk of mastectomy flap necrosis (RR, 2.61; CI, 1.62, 4.20), and partial flap loss (RR, 2.62; CI, 1.23, 5.59) for obese patients compared to nonobese patients. Additionally, there was a fourfold increase in risk for total flap loss (RR, 4.12; CI, 1.01, 16.79) and donor-site seroma (RR, 4.03; CI, 2.46, 6.59). There was no significant difference in the risk for overall donor-site complications between the two populations (RR, 1.09; CI, 0.58, 2.05). Conclusions: The findings reveal that obese patients have a higher risk of complications than nonobese patients receiving abdominal-based free flaps for breast reconstruction. As we move toward a pay-for-performance reimbursement system, appropriate risk adjustments will be a vital component, allowing provision of optimal treatment techniques for obese patients.