AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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89th Annual Meeting Abstracts

Breast Reconstruction with Free Tissue Transfer from the Abdomen in the Morbidly Obese
Shareef Jandali, MD, Jonas A. Nelson, BA, Seema S. Sonnad, PhD, Stephen J. Kovach, MD, Liza C. Wu, MD, Joseph M. Serletti, MD.
University of Pennsylvania Health System, Philadelphia, PA, USA.

Autologous breast reconstruction with free tissue transfer from the abdomen has become an increasingly popular method of reconstruction following mastectomy for breast cancer. This procedure is often performed in overweight or obese patients, and the increase in surgical risk and postoperative complications for obese patients is well-known. However, the effect on a subset of this population, women with severe, or morbid, obesity has never been studied. The purpose of this study is to assess the safety and efficacy of free flap breast reconstruction in the morbid obesity (BMI>40). With the increasing prevalence of obesity, the information gathered should help stratify risk and minimize complications in this growing patient population.
We conducted a retrospective review of our institution’s recent experience with free TRAM, DIEP, and SIEA flap breast reconstruction, including all patients who underwent reconstruction between July 2006 and October 2008. Information collected via electronic chart review included demographics, BMI, PMH, and intraoperative and postoperative complications, including vessel thromboses, abdominal hernia, seroma, hematoma, partial flap loss, total flap loss, and delayed wound healing. Data from all patients with a BMI>40 was compared to data from patients with a BMI<40. A P-value of <0.05 was considered significant. Significant findings from the analysis were then analyzed in a post-hoc fashion to examine trends with increasing BMI.
Four hundred and four patients underwent 612 free flap breast reconstructions during the study period. Twenty-five (6%) of these patients had a BMI>40. Comparing this group to patients with a BMI<40 revealed differences in race (p=0.016), hypertension (p=0.001), diabetes (p<.001), and ASA grade (p40 (p=0.023). Additionally, we found a significant increase in major postoperative complications (thrombosis, venous congestion, flap necrosis) in this group, occurring in 24% of morbidly obese patients vs. 3.8% of those with BMI<40 (p<0.001). Significant differences were also noted in delayed wound healing with 72.0% of the morbidly obese group experiencing this complication compared to 44.2% of patients with a BMI40. Additionally, we noted no difference in the development of hernias between the two groups. In post-hoc analysis, when various cutoff levels for BMI (<25, 25-30, 30-32, 32-34, 34-36, 36-38, 38-40, 40-42, 42-44, 44-48) were analyzed to determine at what point there were significant differences in wound healing outcomes, it was found to occur at a BMI of 30.
Free flap breast reconstruction can safely be performed in the morbidly obese, although this reconstruction may be associated with a higher risk of flap loss, major postoperative complications, and wound healing problems. Patients should be counseled with regards to these potential complications, but should still be offered free flap breast reconstruction as an option in their surgical care.


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