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Effect of Body Mass Index on Outcomes after Prepectoral Breast Reconstruction

Gabriel, Allen MD1; Sigalove, Steven MD2; Sigalove, Noemi M. MD3; Storm-Dickerson, Toni L. MD4; Pope, Nicole MSN, FNP-C, CPSN5; Rice, Jami MSPAS, PA-C6; Maxwell, G. Patrick MD7

Plastic and Reconstructive Surgery: June 5, 2019 - Volume PRS Online First - Issue - p
doi: 10.1097/PRS.0000000000005901
Original Article: PDF Only

Background: Body mass index (BMI) has been shown to be a predictor of outcomes after subpectoral expander/implant reconstruction, with every unit increase in BMI increasing the risk of complications by about 6%. The effect of BMI on complications after prepectoral reconstruction has not yet been evaluated and is the purpose of this study.

Methods: A total of 366 reconstructed breasts from 197 patients were stratified into 5 BMI groups (normal, overweight, and class I, class II, and class III obese) and postoperative complications compared across the groups. Additional analyses were performed using broad classifications of BMI into nonobese and obese as well as normal, overweight, and obese. BMI as an independent predictor of complications was assessed using multivariate logistic regression analysis.

Results: Complication rates did not differ significantly across BMI groups when using the broad classifications. With 5-group stratification, significantly higher rates of return to operating room, expander/implant loss, skin necrosis, wound dehiscence, and overall complications were seen in class II and/or class III obese versus overweight patients. But, on multivariate logistic regression analyses, BMI, as a continuous variable, did not independently predict any complication. Diabetes and smoking emerged as significant predictors of any complication, indicating that these factors, rather than BMI, were driving the increased rates of complications seen in the high BMI groups.

Conclusions: BMI alone is not a predictor of outcomes after prepectoral expander/implant breast reconstruction and should not be used to estimate risk of postoperative complications or exclude patients for prepectoral reconstruction.

1Clinical Associate Professor of Surgery; Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA

2DuPage Medical Group/DMG AESTHETICS, Chairman, Department of Plastic Surgery, Central DuPage Hospital/Northwestern Medicine, Winfield IL

3Breast Program Director, Department of Breast Surgery, Central DuPage Hospital/Northwestern Medicine, Winfield, IL

4Co-director Breast Program, Compass Oncology Breast Specialist, Compass Oncology, Portland, OR and Vancouver, WA

5Plastic Surgery Nurse Practitioner, DuPage Medical Group

6Plastic Surgery Physician Assistant, Peacehealth Medical Group, Vancouver, Wa

7Clinical Professor of Surgery Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA

Financial Disclosure: No funds were received or utilized for the research reported in this paper. A publication grant from Allergan, Madison, NJ, was utilized for writing, editorial, and data analyses assistance.

Author Disclosures: Allen Gabriel, MD; Steven Sigalove, MD; and G. Patrick Maxwell, MD are consultants for Allergan, Madison, NJ. Noemi M. Sigalove, MD and Toni L. Storm-Dickerson, MD are speakers for Allergan.

Acknowledgement: Writing and editorial assistance was provided by Kalanethee Paul-Pletzer, PhD, and data analyses by Vadim A. Pletzer.

Corresponding Author Contact Information: Allen Gabriel, MD, FACS, Department of Plastic Surgery, 505 NE, 87th Avenue, Suite 250, Vancouver, WA 98664, Phone: 360-514-1010, Fax: 360-514-1011,

©2019American Society of Plastic Surgeons