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 - Funding Information:
Data collection and analyses were supported by a National Institutes of Health, National Cancer Institute R01 grant (5R01CA152192-04).
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.
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U2 - 10.1097/PRS.0000000000006543
DO - 10.1097/PRS.0000000000006543
M3 - Article
C2 - 32097295
AN - SCOPUS:85080047265
SN - 0032-1052
SP - 481E-490E
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
ER -