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The Impact of Autologous Breast Reconstruction on Body Mass Index Patterns in Breast Cancer Patients: A Propensity-Matched Analysis

Cho, Eugenia H. B.S.; Shammas, Ronnie L. B.S.; Glener, Adam D. B.S.; Greenup, Rachel A. M.D., M.P.H.; Hwang, E. Shelley M.D., M.P.H.; Hollenbeck, Scott T. M.D.

Plastic and Reconstructive Surgery: December 2017 - Volume 140 - Issue 6 - p 1121–1131
doi: 10.1097/PRS.0000000000003841
Breast: Original Articles
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Background: Weight gain is common in breast cancer patients and increases the risk of recurrence and mortality. The authors assessed the impact of autologous breast reconstruction on body mass index patterns after diagnosis in mastectomy patients.

Methods: Women undergoing therapeutic mastectomy at the authors’ institution from 2008 to 2010 were identified. Patients undergoing no breast reconstruction or autologous breast reconstruction were propensity-matched by age at diagnosis, baseline obesity, mastectomy laterality, and adjuvant therapies. Multivariable regression was used to estimate covariate associations with percentage body mass index change and percentage body mass index change greater than 5.0 percent at 1 to 4 years after diagnosis.

Results: Of 524 total patients, 80 propensity-matched pairs were identified. In multivariable regression, women undergoing immediate autologous breast reconstruction had reduced body mass index changes after diagnosis, compared with nonreconstruction patients, at 1 year (β = −5.25 percent; p < 0.01), 2 years (β = −8.78 percent; p < 0.01), and 3 years (β = −7.21 percent; p < 0.01). After 4 years, all autologous reconstruction was predictive of reduced body mass index changes (β = −3.54 percent; p = 0.02). Higher body mass index increases were observed among women who were leaner at diagnosis (p < 0.01 at 1 year) and received chemotherapy (p = 0.02 at 3 years; p = 0.04 at 4 years).

Conclusions: Women undergoing autologous breast reconstruction gained less weight after diagnosis than nonreconstruction patients. Normal baseline body mass index and chemotherapy were predictive of greater body mass index increases. These findings may guide targeted weight management strategies in high-risk patients to maximize survival rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Durham, N.C.; and Philadelphia, Pa.

From the Divisions of Plastic and Reconstructive Surgery and Advanced Oncologic and Gastrointestinal Surgery, Duke University Medical Center; and the Department of Bioengineering, University of Pennsylvania.

Received for publication April 1, 2017; accepted July 6, 2017.

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

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch. On the iPad, tap on the Hot Topics icon.

Scott T. Hollenbeck, M.D., Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Box 3945, Durham, N.C. 27710, scott.hollenbeck@duke.edu

©2017American Society of Plastic Surgeons