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Body Mass Index as a Continuous Predictor of Outcomes After Expander-Implant Breast Reconstruction

Nguyen, Khang T. BA*; Hanwright, Philip J. BS*; Smetona, John T. BS*; Hirsch, Elliot M. MD*†; Seth, Akhil K. MD*†; Kim, John Y.S. MD*†

doi: 10.1097/SAP.0b013e318276d91d
Breast Surgery

Background Studies show that obesity is a risk factor for complications after expander/implant breast reconstructions. However, reports vary on the precise threshold of body mass index (BMI) as a predictor of heightened risk. We endeavored to link BMI as a continuous variable to overall complications in a single-surgeon series of expander-implant reconstructions.

Methods From 399 patients undergoing expander-implant reconstruction, 551 breasts were stratified to normal weight, overweight, and obese groups for analysis and comparison with previous studies. Logistic regression was performed to predict changes to risk profile per increment of BMI.

Results Complication rates for obese and overweight patients were significantly greater than for normal weight patients, that is, 21.1% and 24.0% versus 10.4%, respectively (P < 0.005). A unit increase in BMI predicted a 5.9% increase in the odds of a complication occurring, and 7.9% increase in the odds of reconstruction ending in failure.

Conclusions By expanding the analysis of BMI to include patients who do not meet the traditional definition of obesity (BMI ≥ 30 kg/m2), we demonstrated that simply overweight patients (25 ≤ BMI < 30 kg/m2) had an elevated complication rate. Moreover, through regression analysis, we established that BMI as a continuous variable predicts outcomes from expander-based breast reconstruction.

From the *Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University; and †Northwestern Memorial Hospital, Chicago, IL.

Received July 29, 2012, and accepted for publication, after revision, September 28, 2012.

Conflicts of interest and sources of funding: Dr Kim receives research funding from and is a consultant for the Musculoskeletal Transplant Foundation and Mentor. The remaining authors have nothing to disclose.

Reprints: John Yah-Sung Kim, MD, Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, 675 N St Clair St, Galter Suite 19-250, Chicago, IL 60611. E-mail:

© 2014 by Lippincott Williams & Wilkins