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The advantages of free abdominal-based flaps over implants for breast reconstruction in obese patients.

Abstract：

BACKGROUND:The authors hypothesized that, for obese patients, delayed abdominal-based free flap (rather than implant-based and immediate) breast reconstruction would result in fewer overall complications and reconstruction losses. METHODS:The authors retrospectively analyzed consecutive implant- and abdominal-based free flap breast reconstructions performed in obese patients between 2005 and 2010 by utilizing the World Health Organization obesity classifications: class I, 30.0 to 34.9 kg/m2; class II, 35.0 to 39.9 kg/m2; and class III, ≥40 kg/m2. Primary outcome measures included flap failures and overall complications. Logistic regression analysis identified associations among patient, defect, and reconstructive characteristics and surgical outcomes. RESULTS:The analysis included 990 breast reconstructions (548 flaps versus 442 implants) in 700 patients. Mean follow-up was 17 months. Age, smoking, medical illness, and body mass index greater than 37 predicted overall complications on regression analysis. Implants demonstrated a higher failure rate (15.8 percent) than flaps (1.5 percent). Although failure rates were similar for immediate and delayed flap reconstructions overall (1.3 versus 1.9 percent) and among obesity classifications, there was a trend toward more implant failures in immediate rather than delayed reconstructions (16.8 versus 5.3 percent). Differences between immediate implant versus flap reconstruction failure rates were highest among more obese patients [class II (24.7 versus 1.3 percent) and class III (25.4 versus 0 percent) compared with class I (11.7 versus 1.4 percent)]. CONCLUSIONS:Obese patients (particularly class II and III) experience higher failure rates with implant-based breast reconstruction, particularly immediate reconstruction. Free flap techniques or delayed implant reconstruction may be warranted in this population. CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, II.

journal_name

Plast Reconstr Surg

journal_title

Plastic and reconstructive surgery

authors

Garvey PB,Villa MT,Rozanski AT,Liu J,Robb GL,Beahm EK

doi

10.1097/PRS.0b013e318267efc5

subject

Has Abstract

pub_date

2012-11-01 00:00:00

pages

991-1000

issue

eissn

0032-1052

issn

1529-4242

pii

00006534-201211000-00004

journal_volume

130

pub_type

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The advantages of free abdominal-based flaps over implants for breast reconstruction in obese patients.