The Impact of Obesity on Patient Reported Outcomes Following Autologous Breast Reconstruction with Free Abdominal Tissue
Aadit Patel, MD, Nikhil Sobti, Robert J. Allen, Jr., MD, Evan Matros, MD, Colleen M. McCarthy, MD, Joseph H. Dayan, MD, Joseph J. Disa, MD, Peter G. Cordeiro, MD, Babak J. Mehrara, MD, Andrea L. Pusic, MD, Jonas A. Nelson, MD.
Memorial Sloan Kettering Cancer Center, Brooklyn, NY, USA.
Background: Numerous investigations have identified obesity as an independent risk factor for post-operative complication following autologous breast reconstruction. Despite the availability of studies evaluating obesity-related surgical outcomes, few have assessed satisfaction from the patient perspective within an obese patient population. The purpose of our study was to investigate the association between patient satisfaction and obesity to guide clinical decision-making. We hypothesize that patient satisfaction will not differ significantly between obese and non-obese groups following autologous breast reconstruction with abdominal free flap.
Methods: An IRB approved investigation was conducted to evaluate patients undergoing autologous breast reconstruction at a tertiary academic medical center. Since 2009, patients have completed the BREAST-Q as part of their standard of care in reconstruction. In the present study, the reconstruction module was used to assess patient-reported outcomes between non-obese and obese autologous reconstruction patients, with a focus on satisfaction with breasts and abdominal well-being.
Results: A total of 404 patients who underwent autologous breast reconstruction with abdominal free-tissue transfer were included. One hundred and sixty patients (39.6%) presented as obese (BMI > 30) whereas the remaining 244 (60.4%) had a recorded BMI < 30. Pre-operative BREAST-Q scores were compared between the patient cohorts to establish baseline measure of patient satisfaction with regard to body habitus. Obese patients scored lower in satisfaction with breasts in the pre-operative period within obese population compared to non-obese patients (mean, 40.7 (24.0) v. 50.4 (22.2), respectively, p = 0.04). Conversely, no significant differences in satisfaction with breasts following cross-sectional analysis at the aforementioned postoperative time points were noted. However, obese patients reported lower abdominal donor
site satisfaction scores at 3-year follow-up (mean, 75.9 ± 22.6 v. 84.9 ± 17.3, respectively, p = 0.04).
Conclusion: These results suggest that, although obese patients are more likely to present with dissatisfaction with their breasts in the pre-operative period, they exhibit similar postoperative patient-reported satisfaction compared to their non-obese counterparts. However, obese patients may have worse outcomes regarding their donor site. This study can be used to guide clinical decision making and counseling of obese patients who are considering autologous breast reconstruction with abdominal free tissue transfer.
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