Abdominally based free flap breast reconstruction in the severely obese population: Is it safe?

• Published in: Microsurgery Vol. 43; no. 5; pp. 483 - 489
• Main Authors: Mather, Tara L., Tobin, Chase, Tillman, Rachel, Doren, Erin, LoGiudice, John, Adamson, Karri
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.07.2023; Wiley Subscription Services, Inc
• Subjects: Body mass; Body mass index; Body size; Breast cancer; Breast Neoplasms - complications; Breast Neoplasms - surgery; Complications; Demographics; Female; Free Tissue Flaps - surgery; Hernia; Humans; Mammaplasty - adverse effects; Mastectomy - adverse effects; Morbidity; Necrosis; Obesity; Obesity - complications; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Reconstructive surgery; Retrospective Studies; Risk factors; Surgeons; Surgery
• ISSN: 0738-1085; 1098-2752
• DOI: 10.1002/micr.31025

Introduction Class 3 (severe) obesity is defined as a body mass index (BMI) greater than 40 kg/m2. Obesity is common and an independent risk factor for breast cancer. The plastic surgeon will be tasked with providing reconstruction for obese patients after mastectomy. This presents a surgical dilemma because patients with elevated BMI are known to have greater rates of morbidity when undergoing free flap reconstruction, however free flap reconstruction is associated with greater functional and aesthetic outcomes. This study quantifies complication rates in a cohort of patients with class 3 obesity that underwent abdominally based free flap breast reconstruction. This study may be able answer whether this surgery is feasible or safe. Methods Patients with a class 3 obesity who underwent abdominally‐based free flap breast reconstruction between January 1, 2011 and February 28, 2020 at the authors' institution were identified. A retrospective chart review was performed to record patient demographics and peri‐operative data. Results Twenty‐six patients met inclusion criteria. Eighty percent of patients had at least one minor complication including infection (42%), fat necrosis (31%), seroma (15%), abdominal bulge (8%), and hernia (8%). Thirty‐eight percent of patients had at least one major complication (requiring readmission (23%) and/or a return to the operating room (38%)). No flaps failed. Conclusion Abdominally based free flap breast reconstruction in patients with class 3 obesity is associated with great morbidity, however, no patients experienced flap loss or failure which may imply that this population can safely undergo surgery so long as the surgeon is prepared for complications and takes steps to mitigate risk.