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Comparing Outcomes Following Autologous Breast Reconstruction by Body Mass Index Stratification
Ariel Gabay
*1, Areeg A. Abu El Hawa
1, Lillian A. Boe
2, Carrie S. Stern
1, Joseph Disa
1, Babak J. Mehrara
1, Robert J. Allen
1, Jonas Nelson
11Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York , NY; 2Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
Background: Autologous breast reconstruction (ABR) provides durable reconstructive outcomes and high patient satisfaction. Although prior studies have evaluated outcomes following ABR by body mass index (BMI), data incorporating patient-reported outcomes remain limited. This study aimed to compare 1-year BREAST-Q scores and complication rates across three BMI cohorts in patients who underwent ABR.
Methods: A retrospective review of female patients ≥18 years of age who underwent autologous breast reconstruction between January 2010 and December 2024 at Memorial Sloan Kettering Cancer Center were included. Patients were stratified into three BMI cohorts: <21, 21-25, and 25-30. The primary outcome was 1-year BREAST-Q scores, and secondary outcomes included postoperative complications at any time.
Results: Of 2,366 patients included, 263 had BMI <21, 936 had BMI 21-25, and 1,167 had BMI 25-30. DIEP flap was the predominant reconstruction type (72%), followed by TRAM (13%). At 1 year, the BMI <21 cohort demonstrated significantly higher Physical Well-being: Chest scores (median 85 vs. 76 vs. 76; p=0.007) and Physical Well-being: Abdomen scores (median 76 vs. 70 vs. 69; p<0.001). Satisfaction with Breasts, Psychosocial Well-being, and Sexual Well-being were equivalent across cohorts (p=0.6, p=0.2, p=0.6). For complications, mastectomy skin flap necrosis was lowest in the BMI <21 group (5.7%; p=0.029), while thirty-day readmission rates were lowest in the BMI 21-25 cohort (5.0%; p=0.033). All other complications were comparable across groups.
Conclusions: Physical well-being scores at 1 year favored lower-BMI patients, while breast satisfaction, psychosocial well-being, and sexual well-being appeared equivalent across BMI cohorts. These findings may inform preoperative counseling by suggesting that BMI within this range is not a primary determinant of patient-reported satisfaction, while highlighting the importance of setting realistic expectations regarding physical recovery for patients with a higher BMI.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
Back to 2026 Abstracts
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
