Effect of obesity on outcomes of free autologous breast reconstruction: A meta-analysis

Background The prevalence of obesity is rising in Western society. The aim of this meta-analysis was to evaluate the available evidence regarding the effect of obesity on outcomes of free autologous breast reconstruction. Methods Pubmed, Ovid MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and clinicaltrials.gov were searched. Obesity was defined as a BMI ≥ 30. Comparable data from observational studies was combined for pooled analysis and quality assessment of observational studies was performed. Results Fourteen studies met the inclusion criteria (n = 6,043 patients). Pooled data analysis demonstrated significantly higher prevalences of overall complications, recipient site complications overall, donor site complications overall, donors site wound infection, donor site seroma, abdominal bulge/hernia, mastectomy skin flap necrosis, recipient site delayed wound healing, and partial flap failure, in obese (BMI ≥ 30) compared with nonobese (BMI < 30) patients. A BMI of 40 was identified as a threshold at which the prevalence of complications became prohibitively high. No randomized-controlled trials were found and all studies had methodological weaknesses. Conclusions Complications in obese patients following free autologous breast reconstruction were higher than in their nonobese counterparts; however the majority of these complications were reported in the studies as being minor. Until better evidence is available this information will help when counseling patients.