TY - JOUR
T1 - Obesity and Breast Reconstruction
T2 - Complications and Patient-Reported Outcomes in a Multicenter, Prospective Study
AU - Srinivasa, Dhivya R.
AU - Clemens, Mark W.
AU - Qi, Ji
AU - Hamill, Jennifer B.
AU - Kim, Hyungjin M.
AU - Pusic, Andrea L.
AU - Wilkins, Edwin G.
AU - Butler, Charles E.
AU - Garvey, Patrick B.
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - BACKGROUND: The authors' purpose was to evaluate the effects of body mass index, as defined by World Health Organization criteria, on complications and patient-reported outcomes in implant-based and autologous breast reconstruction.METHODS: Complications and BREAST-Q patient-reported outcomes were analyzed 2 years after breast reconstruction for women from 11 participating sites. Separate mixed-effects regressions were performed to assess body mass index effects on outcomes.RESULTS: A total of 2259 patients (1625 implant-based and 634 autologous) were included. Women with class II/III obesity had higher risks of any complication in both the implant (OR, 1.66; p = 0.03) and autologous (OR, 3.35; p < 0.001) groups, and higher risks of major complications in both the implant (OR, 1.71, p = 0.04) and autologous (OR, 2.72; p = 0.001) groups, compared with underweight/normal weight patients. Both class I (OR, 1.97; p = 0.03) and class II/III (OR, 3.30; p = 0.001) obesity patients experienced higher reconstructive failures in the implant cohort. Class I obesity implant patients reported significantly lower Satisfaction with Breasts scores (mean difference, -5.37; p = 0.007). Body mass index did not significantly affect patient-reported outcomes for autologous reconstruction patients.CONCLUSIONS: Obesity was associated with higher risks for complications in both implant-based and autologous breast reconstruction; however, it only significantly affected reconstruction failure and patient-reported outcomes in the implant reconstruction patients. Quality-of-life benefits and surgical risk should be presented to each patient as they relate to her body mass index, to optimize shared decision-making for breast reconstruction.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, I.
AB - BACKGROUND: The authors' purpose was to evaluate the effects of body mass index, as defined by World Health Organization criteria, on complications and patient-reported outcomes in implant-based and autologous breast reconstruction.METHODS: Complications and BREAST-Q patient-reported outcomes were analyzed 2 years after breast reconstruction for women from 11 participating sites. Separate mixed-effects regressions were performed to assess body mass index effects on outcomes.RESULTS: A total of 2259 patients (1625 implant-based and 634 autologous) were included. Women with class II/III obesity had higher risks of any complication in both the implant (OR, 1.66; p = 0.03) and autologous (OR, 3.35; p < 0.001) groups, and higher risks of major complications in both the implant (OR, 1.71, p = 0.04) and autologous (OR, 2.72; p = 0.001) groups, compared with underweight/normal weight patients. Both class I (OR, 1.97; p = 0.03) and class II/III (OR, 3.30; p = 0.001) obesity patients experienced higher reconstructive failures in the implant cohort. Class I obesity implant patients reported significantly lower Satisfaction with Breasts scores (mean difference, -5.37; p = 0.007). Body mass index did not significantly affect patient-reported outcomes for autologous reconstruction patients.CONCLUSIONS: Obesity was associated with higher risks for complications in both implant-based and autologous breast reconstruction; however, it only significantly affected reconstruction failure and patient-reported outcomes in the implant reconstruction patients. Quality-of-life benefits and surgical risk should be presented to each patient as they relate to her body mass index, to optimize shared decision-making for breast reconstruction.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, I.
KW - Adult
KW - Body Mass Index
KW - Breast Neoplasms/surgery
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Mammaplasty/adverse effects
KW - Mastectomy/adverse effects
KW - Middle Aged
KW - Obesity/complications
KW - Patient Reported Outcome Measures
KW - Patient Satisfaction
KW - Postoperative Complications/epidemiology
KW - Prospective Studies
KW - Quality of Life
KW - Risk Assessment
KW - Risk Factors
KW - Treatment Outcome
KW - United States/epidemiology
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U2 - 10.1097/PRS.0000000000006543
DO - 10.1097/PRS.0000000000006543
M3 - Article
C2 - 32097295
SN - 0032-1052
VL - 145
SP - 481e-490e
JO - Plastic and Reconstructive Surgery
JF - Plastic and Reconstructive Surgery
IS - 3
ER -