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The Impact of Obesity on Patient Satisfaction with Breast Reconstruction

Atisha, Dunya M. M.D.; Alderman, Amy K. M.D., M.P.H.; Kuhn, Latoya E. M.P.H.; Wilkins, Edwin G. M.D., M.S.

Plastic and Reconstructive Surgery: June 2008 - Volume 121 - Issue 6 - p 1893-1899
doi: 10.1097/PRS.0b013e3181715198
Breast: Original Articles

Background: As the U.S. population becomes increasingly overweight, a growing number of patients with body mass indexes greater than 30 are seeking mastectomy reconstruction. The authors' purpose was to prospectively evaluate the effect of body mass index on patient satisfaction with breast reconstruction.

Methods: Women undergoing first-time breast reconstruction at one of 12 centers in the United States and Canada were surveyed preoperatively and at postoperative year 1. Satisfaction was evaluated with two scales assessing general and aesthetic satisfaction. Using Centers for Disease Control and Prevention criteria, patients were classified as normal weight, overweight, or obese. Logistic regressions evaluated the effects of body mass index on patient satisfaction with expander/implant, pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, and free TRAM flap techniques while controlling for patient age and timing of reconstruction.

Results: Data were available for a total of 262 patients. Patient body mass index had a significant effect on aesthetic satisfaction, particularly among patients undergoing expander/implant procedures. Compared with normal weight individuals, obese patients with expander/implants were significantly less satisfied aesthetically (odds ratio, 0.14, p = 0.02). However, there was no significant difference between obese and normal weight patients in aesthetic satisfaction with TRAM flap reconstruction. Finally, body mass index had no significant effects on general satisfaction for either expander/implant or TRAM flap technique.

Conclusion: Although previous investigators have reported relatively high complication rates and modest aesthetic results for breast reconstruction in overweight and obese women, the authors' study suggests that patient satisfaction with reconstruction is surprisingly high in this population, particularly in cases of autogenous tissue reconstruction.

Ann Arbor, Mich.

From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical Center; Department of Surgery, St. Joseph Mercy Hospital; and Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Health Care System.

Received for publication April 20, 2007; accepted August 21, 2007.

Edwin Wilkins, M.D., M.S.; Plastic and Reconstructive Surgery; University of Michigan; 2130 Taubman Center; 1500 East Medical Center Drive; Ann Arbor, Mich. 48109-0340;

Disclosure: None of the authors has any financial or commercial interests related to this research.

©2008American Society of Plastic Surgeons