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Achieving Patient Satisfaction in Abdominally Based Free Flap Breast Reconstruction: Correlation with Body Mass Index Subgroups and Weight Loss

Larson, Kelsey E. M.D.; Ozturk, Cemile Nurdan M.D.; Kundu, Neilendu M.D.; Cooper, Karen R. D.O.; Bernard, Steven M.D.; Djohan, Risal M.D.

Plastic and Reconstructive Surgery: April 2014 - Volume 133 - Issue 4 - p 763–773
doi: 10.1097/PRS.0000000000000027
Breast: Original Articles

Background: The goal of this study was to evaluate the relationship between body mass index, preoperative weight loss, and patient satisfaction in breast reconstruction with abdominally based free flaps.

Methods: A custom survey with overall, breast, and abdomen questions was sent to patients who underwent abdominally based free flap breast reconstruction over the past 4 years. Clinical data were collected for patients who returned surveys. Data analysis was performed based on body mass index and percentage weight loss before surgery.

Results: One hundred seventy-nine surveys were sent. Ninety-two patients (51.4 percent) responded. Normal weight patients versus overweight patients did not have statistically significant differences in any satisfaction scores. Overweight patients had higher overall satisfaction (p = 0.01), breast-specific satisfaction (p = 0.01), and abdomen-specific satisfaction (p = 0.02) compared with obese patients. Normal weight patients had higher breast-specific satisfaction (p = 0.05) and abdomen-specific satisfaction (p = 0.03) scores compared with obese patients. Patients with significant preoperative weight loss were more satisfied with feeling of breasts in clothes (p = 0.01), social appearance (p = 0.05), and current abdominal appearance (p = 0.01) compared with patients with moderate preoperative weight loss. Overall, breast- and abdomen-specific satisfaction scores decreased with increase in pannus thickness.

Conclusions: Patient satisfaction with abdominally based free flap breast reconstruction was highest in patients with normal body mass index and lowest in obese patients. Overweight or obese patients should be encouraged to participate in healthy weight loss programs to achieve improved postoperative satisfaction.


Cleveland, Ohio

From the Departments of General Surgery and Plastic Surgery and the Women’s Health Institute, Cleveland Clinic.

Received for publication May 15, 2013; accepted September 23, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Risal Djohan, M.D., Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A60, Cleveland, Ohio 44195,

©2014American Society of Plastic Surgeons