Free Tissue Transfer in the Obese Patient
- 1 May 2013
- journal article
- breast
- Published by Ovid Technologies (Wolters Kluwer Health) in Plastic and Reconstructive Surgery
- Vol. 131 (5), 681e-692e
- https://doi.org/10.1097/prs.0b013e31828e2159
Abstract
Background: The authors’ institution has seen an increase in obese and morbidly obese patients seeking autologous breast reconstruction. The authors provide a comprehensive outcome analysis of patients undergoing abdominally based autologous breast reconstruction. Methods: The authors identified obese patients receiving free tissue transfer for breast reconstruction. World Health Organization body mass index criteria were used: nonobese (body mass index, 20 to 29.9 kg/m2), class I (30 to 34.9 kg/m2), class II (35 to 39.9 kg/m2), and class III (>40 kg/m2). Patient comorbidities, body mass index, complications (medical and surgical), and hospital resource use were examined. Results: Eight-hundred twelve patients undergoing 1258 free tissue transfers for breast reconstruction were included. Overall, 66.5 percent (n = 540) were considered nonobese, 22.9 percent (n = 186) had class I obesity, 5.0 percent (n = 41) had class II, and 5.7 percent (n = 45) had class III. Obesity was associated with a significant increase in minor (p = 0.001) and major (p = 0.013) complications. Morbidly obese patients had significantly higher rates of total flap loss (p = 0.006) and longer operative times (p = 0.0002). Complications translated into greater cost and resource consumption (p < 0.001). Muscle-sparing transverse rectus abdominis myocutaneous flap experienced a significantly higher rate of hernia compared with other flaps (p = 0.02), without a difference in flap loss rate (p = 0.61). Conclusions: Increasing obesity is associated with increased perioperative risk in free abdominally based autologous breast reconstruction, which translated into greater perioperative morbidity, higher hospital cost, and increased health care resource consumption. Higher body mass index is directly related to intraoperative technical difficulty, flap loss, donor-site morbidity, and cost use. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.Keywords
This publication has 25 references indexed in Scilit:
- Factors associated with hernia and bulge formation at the donor site of the pedicled TRAM flapEuropean Journal of Plastic Surgery, 2010
- Autologous Breast Reconstruction: The Vanderbilt Experience (1998 to 2005) of Independent Predictors of Displeasing OutcomesJournal of the American College of Surgeons, 2008
- Predicting Complications following Expander/Implant Breast Reconstruction: An Outcomes Analysis Based on Preoperative Clinical RiskPlastic and Reconstructive Surgery, 2008
- The Impact of Obesity on Patient Satisfaction with Breast ReconstructionPlastic and Reconstructive Surgery, 2008
- The Deep Inferior Epigastric Perforator Flap for Breast Reconstruction in Overweight and Obese PatientsPlastic and Reconstructive Surgery, 2005
- An Outcome Study of Breast Reconstruction: Presurgical Identification of Risk Factors for ComplicationsAnnals of Surgical Oncology, 2001
- Evaluation of the Factors Related to Postmastectomy Breast ReconstructionPlastic and Reconstructive Surgery, 2001
- Effect of Obesity on Flap and Donor-Site Complications in Free Transverse Rectus Abdominis Myocutaneous Flap Breast ReconstructionPlastic and Reconstructive Surgery, 2000
- Breast Reconstruction: Systemic Factors Influencing Local ComplicationsAnnals of Plastic Surgery, 1991
- Complications of TRAM Flap Breast Reconstruction in Obese PatientsPlastic and Reconstructive Surgery, 1989