Impact of BMI on Surgical Outcomes and Quality-of-Life in Breast Reduction
Ellen F. Niu*, Chris Amro, Theodore E. Habarth-Morales, Stephanie E. Honig, Harrison Davis, Robyn B. Broach, John P. Fischer
Plastic Surgery, University of Pennsylvania, Philadelphia, PA
The authors sought to determine the impact body mass index (BMI) has on surgical and QoL outcomes in breast reduction.
Patients undergoing BR by two surgeons from 2016-2022 were included. BMI cohorts were formed according to CDC guidelines: BMI 18.5-24.9 kg/m2 (healthy), BMI 25-29.9 kg/m2 (overweight), BMI 30-34.9 kg/m2 (obesity class I), BMI 35-39.9 kg/m2 (obesity class II), and BMI > 40 kg/m2 (obesity class III). QoL was assessed by comparing pre- and postoperative BREAST-Q BR scores within cohorts.
381 patients were identified: 68 were healthy BMI, 146 were overweight, 121 were in obesity class I, 30 were class II, and 16 were class III. As BMI class increased, percentage of Black patients, procedure length, weight of tissue removed, and inferior pedicle technique all significantly increased as BMI cohorts increased (p<0.001). Higher BMI cohorts had significantly higher rates of surgical site infections (SSI) (healthy: 0%, overweight: 1.37%, class I: 1.65%, class II: 0%, class III: 18.75%, p<0.001), fat necrosis (healthy: 1.47%, overweight: 4.11%, class I: 8.26%, class II: 0%, class III: 18.75%, p=0.017), delayed healing (healthy: 4.41%, overweight: 10.96%, class I: 17.36%, class II: 26.67%, class III: 56.25%, p<0.001), minor T-point breakdown (healthy: 11.76%, overweight: 15.75%, class I: 24.79%, class II: 20%, class III: 56.25%, p=0.001), and surgical site occurrence requiring procedural intervention (SSOpi) (healthy: 1.47%, overweight: 1.37%, class I: 5.79%, class II: 3.33%, class III: 25%, p<0.001). Significant improvement in average postoperative QoL scores in satisfaction with breast, psychosocial well-being, sexual well-being, and physical well-being were seen in all BMI cohorts except class III obesity (p<0.001).
The incidence of surgical site occurrences significantly rise as BMI class increases. However, significant improvement in QoL is seen in almost all BMI cohorts suggesting that despite increased incidence of complications, patients in higher BMI classes may still experience an overall benefit.
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