Should we continue to consider obesity a relative contraindication for autologous microsurgical breast reconstruction?

Momeni, Arash; Ahdoot, Michael; Kim, Rebecca Y.; Leroux, Éric; Galaiya, Deepa; Lee, Gordon K.

doi:10.1016/j.bjps.2011.10.005

Cited by 37 publications

(46 citation statements)

References 28 publications

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“…Recently, Momeni et al 42 have questioned the paradigm of avoiding autologous reconstructions for obese patients, and as a corollary, whether expander-implant reconstructions should remain the alternative for these patients. Their retrospective review of 42 autologous reconstructions revealed a 32.1% complication rate in patients with BMI greater than or equal to 35 kg/m 2 and Jandali et al 14 and Momeni et al 42 found a 72% complication rate for autologous reconstructions in patients with BMI greater than or equal to 40 kg/m 2 .…”

Section: Discussionmentioning

confidence: 99%

Body Mass Index as a Continuous Predictor of Outcomes After Expander-Implant Breast Reconstruction

Nguyen¹,

Hanwright²,

Smetona³

et al. 2014

Annals of Plastic Surgery

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Section: Discussionmentioning

confidence: 99%

Body Mass Index as a Continuous Predictor of Outcomes After Expander-Implant Breast Reconstruction

Nguyen¹,

Hanwright²,

Smetona³

et al. 2014

Annals of Plastic Surgery

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“…It is well established that high body mass index (BMI) increases the risk for surgical complications and overall morbidity in all types of breast reconstructions, both implant-based and autologous (46)(47)(48)(49)(50)(51)(52)(53)(54). It is also well established that smoking has a negative influence on free flap breast reconstruction (6,45,(55)(56)(57)(58)(59), although some studies have failed to establish this relationship (4,(60)(61)(62).…”

Section: The Effect Of Patient Characteristics On Breast Reconstructionmentioning

confidence: 99%

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

et al. 2017

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being, health-related quality of life and satisfaction (5,7-10).Patients' satisfaction and health-related quality of life are frequently used as parameters for outcome measurement in plastic surgery. Postoperative complications after breast reconstruction are common and affect patient satisfaction.Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling. 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially.Conclusions: Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.

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“…Obese patients present challenges with obtaining optimal cosmetic results following reconstruction due to well documented risks of higher complication rates as well as the general involvement of larger breast volumes and greater degree of ptosis. 61,62 Although there have been few studies to date evaluating patient-reported outcomes based upon BMI, some research suggests there may be limited differences for obese patients as compared to normal-weight patients. Kulkarni et al found that patient satisfaction with surgical outcomes were similar across BMI categories, with obese patients more likely to receive an autologous reconstruction compared to an implant-based reconstruction.…”

Section: Overview Of Patient-reported Outcomes Research In Breast Recmentioning

confidence: 99%

Developing a theoretical framework to illustrate associations among patient satisfaction, body image and quality of life for women undergoing breast reconstruction

Fingeret

Nipomnick²,

Crosby³

et al. 2013

Cancer Treatment Reviews

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Within the field of breast reconstruction there is increasing focus on patient-reported outcomes related to satisfaction, body image, and quality of life. These outcomes are deemed highly relevant because the primary goal of breast reconstruction is to recreate the appearance of a breast (or breasts) that is satisfying to the patient. Prominent researchers have suggested the need to develop improved standards for outcome evaluation which can ultimately benefit patients as well as physicians. The purpose of this article is to summarize key findings in the area of patient-reported outcomes for breast reconstruction and introduce a theoretical framework for advancing research in this field. We conducted an extensive literature review of outcome studies for breast reconstruction focusing on patient-reported results. We developed a theoretical framework illustrating core patient-reported outcomes related to breast reconstruction and factors associated with these outcomes. Our theoretical model highlights domains and distinguishing features of patient satisfaction, body image, and quality of life outcomes for women undergoing breast reconstruction. This model further identifies a broad range of variables (e.g., historical/premorbid influences, disease and treatment-related factors) that have been found to influence patient-reported outcomes and need to be taken into consideration when designing future research in this area. Additional attention is given to examining the relationship between patient reported outcomes and outside evaluation of breast reconstruction. Our proposed theoretical framework suggests key opportunities to expand research in this area with the goal of optimizing body image adjustment, satisfaction, and psychosocial outcomes for the individual patient.

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Should we continue to consider obesity a relative contraindication for autologous microsurgical breast reconstruction?

Cited by 37 publications

References 28 publications

Body Mass Index as a Continuous Predictor of Outcomes After Expander-Implant Breast Reconstruction

Body Mass Index as a Continuous Predictor of Outcomes After Expander-Implant Breast Reconstruction

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

Developing a theoretical framework to illustrate associations among patient satisfaction, body image and quality of life for women undergoing breast reconstruction

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