Prepectoral Breast Reconstruction in Morbidly Obese Patients
Abstract
Background: Prosthetic breast reconstruction, via the subpectoral approach, in morbidly obese (body mass index ≥ 40 kg/m2) patients has been reported to be associated with an increased risk of perioperative complications and poor outcomes. Further, immediate reconstruction appears to carry a higher risk of poor outcomes than delayed reconstruction in this population. The impact of morbid obesity on outcomes after prepectoral breast reconstruction has not yet been evaluated and is the purpose of this study.
Methods: This retrospective study included all consecutive patients with morbid obesity who underwent prepectoral expander/implant reconstruction between July 2009 to April 2020 in the first author's practice. Patient records were reviewed and data on demographics, comorbidities, radiotherapy use, type of mastectomy, mastectomy specimen weight, and postoperative complications following reconstruction were retrieved. Complications were stratified and compared by timing of reconstruction (immediate versus delayed).
Results: Eighty-five breasts in 45 morbidly obese patients were reconstructed. Postoperative complications occurred in 11 breasts (12.9 percent) and included major skin necrosis (3.5 percent), seroma (4.7 percent), wound dehiscence (5.9 percent), and reconstructive failure (1.2 percent). Timing of reconstruction had little impact on postoperative complications other than major skin necrosis which was significantly higher in the delayed group (11.1 percent versus 1.5 percent).
Conclusions: Prosthetic breast reconstruction via the prepectoral approach can be successfully performed in morbidly obese patients with outcomes approaching those seen in nonobese patients. Patients with morbid obesity should not be denied this reconstructive approach because of their body mass index.
Conclusion: Results of this meta-analysis show a positive effect with use of NPWTi-d in various wound types.
About the Presenters
Erin O’Rorke
I am a third-year medical student based at the Vancouver campus for my clinical rotations. I grew up in Maple Valley, Washington with my brother and my wonderful parents, a mechanic and a bookkeeper. I am the first in my family to attend college, and earned my Bachelor of Science in molecular, cellular, and developmental biology from the University of Washington before attending medical school at Washington State University. I have an interest in developing a career within breast surgery, specifically reconstruction after procedures such as mastectomies. I am also passionate about increasing female representation in surgery. I love to explore the outdoors in my free time. My most recent trips include Joshua Tree National Park, the Redwood Forest, and Banff, Canada.