Breast reconstruction not as safe for obese patients

ASPS study reveals high BMI means high complication rate

ARLINGTON HEIGHTS, Ill. -- Significantly obese women may wish to consider delaying breast reconstruction following mastectomy until they achieve a healthier body weight. According to findings presented today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2006 conference in San Francisco, women who are significantly obese are at higher risk for complications and have a lower satisfaction rate than do normal and overweight patients.

"Just because someone is overweight doesn't mean they should not be entitled to undergo breast reconstruction after mastectomy," said Elisabeth Beahm, MD, ASPS Member Surgeon, author of the study, and associate professor at M. D. Anderson Cancer Center. "Feeling 'whole' can be an integral part of recovery from cancer, yet significant concerns have been raised about the wisdom of doing breast reconstruction in very obese patients due to a high complication rate.

The current retrospective study found that patients with a BMI greater than 35 demonstrated significantly increased complication rates for all types of breast reconstruction, from implants to flaps. The complication rate approached 100 percent for morbidly obese patients with a BMI over 40.

"We investigated whether plastic surgeons can safely perform breast reconstruction for these patients or if we would be depriving them reconstruction simply because of empiric concerns for their weight," said Dr. Beahm. "We found that significantly obese patients, those having a BMI of 35 or higher, had a higher risk for complications. Our experience suggests that in many cases it may be more prudent to delay breast reconstruction until the patient has lost weight."

The most frequent complications for obese patients were fluid collections and infection at both the reconstructive site and the flap donor site. When the flap was harvested from the abdominal area, weakness and deformity of the abdominal wall such as hernia and bulge was much more common than in normal weight patients.

"While it's very difficult to tell a patient she needs to wait for breast reconstruction, patient safety is our primary concern," said Dr. Beahm. "We must not compromise the oncologic imperative in breast cancer. Each case must be individualized. Morbidly obese patients need to work with their plastic surgeons and carefully assess risk factors. Patients may be best served by deferring breast reconstruction until they have achieved and maintained a lower BMI through exercise and nutrition."

Note: "Breast Reconstruction in the Obese Patient" is being presented Sunday, Oct. 8, 1:15 p.m., at the Moscone Convention Center, San Francisco. Reporters can register to attend Plastic Surgery 2006 and arrange interviews with presenters during the conference by logging on to www.plasticsurgery.org/news_room/Registration.cfm or by contacting ASPS Public Relations at (847) 228-9900 or in San Francisco, Oct. 7-11 at (415) 905-1730.

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For referrals to ASPS Member Surgeons certified by the American Board of Plastic Surgery, call 888-4-PLASTIC (475-2784) or visit www.plasticsurgery.org where you can also learn more about cosmetic and reconstructive plastic surgery.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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