Spitz Jamie A, Bradford Perry S, Aguilar Frank, Turin Sergey Y, Ellis Marco F
Ann Plast Surg. 2018 Feb;80(2):137-140. doi: 10.1097/SAP.0000000000001284.
Obesity is a major public health concern in the United States, affecting nearly 79 million people. There have been promising results performing microvascular breast reconstruction in patients with obesity; however, the definition of obesity is often poorly defined or does not extend above a body mass index (BMI) of 35. Our goal was to examine outcomes of microvascular breast reconstruction in this questionably more risky population.
A retrospective review from 2013 to 2016 was performed of 2 surgeons' experience with abdominally based microvascular breast reconstructions. Women were categorized by BMI into the following groups: normal (18.5-24.9 kg/m), overweight (25.1-29.0 kg/m), class I (30.0-34.9 kg/m), class II (35.0-39.9 kg/m), and class III (>40 kg/m). Demographics included history of tobacco use, breast cancer diagnosis, adjuvant care, and comorbidities. Complications evaluated included donor site (delayed wound healing, fat necrosis, dehiscence, infection, abdominal hernia/bulge, and seroma), recipient site (delayed wound healing and fat necrosis), and need for reoperation. Statistical analyses were performed using analysis of variance and χ test.
A total of 90 women (117 breasts) underwent microsurgical breast reconstruction using abdominal tissue. Twenty-seven women (48 breasts) met criteria for class II and class III obesity (BMI 35-53). Mean follow-up was 24 months. No statistically significant difference was found in demographics among all groups. There was a trend toward variability in overall complications across the BMI groups (P = 0.149). Donor site complications had a significant variation across the different BMI groups (P = 0.016). The rate of donor site complications was similar in class II (8/14) and class III (7/13) obese women. Recipient site complications were similar across the BMI groups.
We found obese women to have a higher rate of abdominal donor site complications; however, this risk seems to level off at class I or II obesity. We have modified our surgical technique of managing the abdominal donor site to optimize our outcomes in the morbidly obese patient population.
肥胖是美国主要的公共卫生问题，影响着近7900万人。对肥胖患者进行微血管乳房重建已取得了有前景的结果；然而，肥胖的定义往往不明确，或者未超出体重指数（BMI）35的范围。我们的目标是研究在这个风险可能更高的人群中进行微血管乳房重建的结果。
对2013年至2016年2位外科医生进行腹壁微血管乳房重建的经验进行回顾性研究。根据BMI将女性分为以下几组：正常（18.5 - 24.9kg/m）、超重（25.1 - 29.0kg/m）、I级（30.0 - 34.9kg/m）、II级（35.0 - 39.9kg/m）和III级（>40kg/m）。人口统计学信息包括吸烟史、乳腺癌诊断、辅助治疗和合并症。评估的并发症包括供区（伤口愈合延迟、脂肪坏死、裂开、感染、腹部疝/膨出和血清肿）、受区（伤口愈合延迟和脂肪坏死）以及再次手术的需求。使用方差分析和χ检验进行统计分析。
共有90名女性（117侧乳房）使用腹部组织进行了显微外科乳房重建。27名女性（48侧乳房）符合II级和III级肥胖标准（BMI 35 - 53）。平均随访时间为24个月。所有组在人口统计学方面未发现统计学上的显著差异。BMI组之间总体并发症存在差异趋势（P = 0.149）。供区并发症在不同BMI组之间有显著差异（P = 0.016）。II级（8/14）和III级（7/13）肥胖女性的供区并发症发生率相似。BMI组之间受区并发症相似。
我们发现肥胖女性腹部供区并发症发生率较高；然而，这种风险在I级或II级肥胖时似乎趋于平稳。我们已经改进了处理腹部供区的手术技术，以优化病态肥胖患者群体的手术效果。
