Breast reconstruction not as safe for obese women
Women who are significantly obese are much more likely to experience complications from breast reconstruction surgery following mastectomy compared with normal weight and overweight women, research indicates.
“Obese women need to understand that they are going to have more complications from breast reconstruction surgery,” Dr. Elisabeth K. Beahm told Reuters Health. “There may be instances where they should delay breast reconstruction until they have lost some weight to a more acceptable body mass index (BMI)—not that they have to become thin, but until they get into a safer weight category,” she said.
Beahm and colleagues from M. D. Anderson Cancer Center in Houston reviewed the outcomes by BMI category of 3,518 women who underwent breast reconstruction.
BMI reflects weight in relation to height, with scores between 20 and 25 classified as normal, 25 to 30 as overweight, over 30 as obese, and 40 or higher morbidly obese.
“We found that with a BMI of 35, which is midway between the obese and morbidly obese, the complications of the surgery were really prohibitive,” Beahm told Reuters Health. “That held constant and was significant for all the different types of breast reconstruction—from implants to flaps.”
When the BMI was over 40, the complication rate approached 100 percent.
“In the lesser obese category and the overweight category,” Beahm noted, “there was not as strong a statistical relationship, but the data suggest that at a BMI of 35 complications from breast reconstruction were really a problem.”
The most common complications for obese patients were related to the surgery such as wound healing and infection at both the reconstructive site and the flap donor site (the abdomen or lower back).
In a small subset of women, Beahm’s team looked at patient satisfaction and overall aesthetic outcome and found that in the higher weight category (BMI of 35 or above) patients were less satisfied with the results and that seemed to relate to the complications.
Beahm concludes that for women with a BMI of “35 or greater, it really may be prudent to wait to undergo breast reconstruction.” She presented the findings at the American Society of Plastic Surgeons annual meeting in San Francisco.
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