Rates of major complications and flap loss for abdominally based breast reconstruction in obese patients are independent of WHO class of obesity

Abstract

Introduction: Obesity is a risk factor for complications following autologous breast reconstruction. Little is known regarding outcomes based on the degree of obesity. This study compares breast reconstruction outcomes and complication rates for the three classes defined by the body mass index (BMI)-based WHO classification.

Methods: The authors conducted a retrospective chart review identifying obese patients who underwent abdominally based breast reconstruction between January 2011 and January 2021. Patients were stratified by BMI class [class 1 (C1) = 30-34.99 kg/m², class 2 (C2) = 35-39.99 kg/m², and class 3 (C3) = 40 kg/m² + ]. Outcomes were compared.

Results: A total of 232 patients (395 flaps) were included with 138 patients were classified as C1, 68 patients as C2, and 26 patients as C3. Rates of any complication (80%) and at least one major complication (31%) did not vary significantly (P = 0.057, 0.185). Individual rates of 30-day readmission (18%) or reoperation (26%) did not vary significantly (P = 0.588 and 0.059). Rates of seroma (C1 = 15%, C2 = 16%, and C3 = 35%), hernia (C1 = 0%, C2 = 4%, and C3 = 8%), and incisional dehiscence (C1 = 30%, C2 = 44%, and C3 = 62%) were associated with significantly increased risk with higher classes of obesity (P < 0.05). The rate of flap failure did not vary significantly (P = 0.573).

Conclusion: The risk of major complications and total flap loss associated with abdominally based breast reconstruction does not differ between the classes of obesity. Although complication rates are high overall in the obese population, detrimental complications do not vary between the classes. Patients should be counseled regarding their individual risk without the need for arbitrary BMI cutoffs.

Keywords: Autologous breast reconstruction; Breast reconstruction; Morbid obesity; Obesity; Obesity class; Surgical outcomes.