Boczar Daniel, Huayllani Maria T, Forte Antonio J, Rinker Brian
From the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL.
Ann Plast Surg. 2020 Jun;84(6S Suppl 5):S361-S363. doi: 10.1097/SAP.0000000000002284.
The obesity epidemic has led to larger numbers of obese patients seeking breast reconstruction. The aim of this study was to compare complication rates and patient satisfaction between obese and nonobese women undergoing autologous breast reconstruction using abdominal free flaps.
The records of all patients who underwent microsurgical breast reconstruction by one surgeon for 15 years were reviewed. Patients were divided into obese (body mass index [BMI] ≥ 30 kg/m and nonobese groups. Demographic data, medical and smoking history, cancer type and treatments, surgical details, and complications were recorded. Breast-Q surveys were mailed to all patients, and satisfaction ratings were compared between obese and nonobese patients.
There were 109 patients and 149 breast reconstructions, with a mean age of 49 years. Follow-up ranged from 6 to 112 months (median = 19 months). There were 59 patients in the obese group and 52 in the nonobese group. The 2 groups did not differ significantly in median age, follow-up, pathology type, presence of chemotherapy or radiation, or smoking history. Obese group had a higher incidence of mastectomy flap necrosis (19.3% vs 7.7%, P < 0.01) and a higher rate of unplanned reoperations (38.6% vs 21.1%, P < 0.01). Obesity was not associated with a higher risk of microsurgical complications or flap loss (7.0% vs 3.8%, P = 0.21). Overall wound complications did not differ between the groups, but the obese group had a higher rate of severe wound complications requiring operative intervention (15.8% vs 3.8%, P < 0.01). The obese group had a higher incidence of hernia or bulge (10.5% vs 0%, P = 0.03). Thirty-three patients returned completed surveys (response rate of 30%). There was no statistically significant difference in any Breast-Q category associated with BMI.
Obesity was associated with higher rates of wound complications, reoperation, and abdominal bulge after microsurgical breast reconstruction. However, patient satisfaction remained high. Patients should be counseled regarding their relative risks, but high BMI should not be considered an absolute contraindication for microsurgical breast reconstruction.
肥胖症的流行导致越来越多肥胖患者寻求乳房重建。本研究的目的是比较采用腹部游离皮瓣进行自体乳房重建的肥胖女性和非肥胖女性的并发症发生率及患者满意度。
回顾了由一位外科医生进行15年显微外科乳房重建的所有患者的记录。患者分为肥胖组（体重指数[BMI]≥30kg/m²）和非肥胖组。记录人口统计学数据、病史和吸烟史、癌症类型及治疗情况、手术细节和并发症。向所有患者邮寄了乳房Q调查问卷，并比较肥胖患者和非肥胖患者的满意度评分。
共有109例患者，149例乳房重建，平均年龄49岁。随访时间为6至112个月（中位数 = 19个月）。肥胖组有59例患者，非肥胖组有52例患者。两组在年龄中位数、随访时间、病理类型、是否接受化疗或放疗以及吸烟史方面无显著差异。肥胖组乳房切除皮瓣坏死的发生率较高（19.3%对7.7%，P < 0.01），计划外再次手术率也较高（38.6%对21.1%，P < 0.01）。肥胖与显微外科并发症或皮瓣丢失的较高风险无关（7.0%对3.8%，P = 0.21）。两组总体伤口并发症无差异，但肥胖组需要手术干预的严重伤口并发症发生率较高（15.8%对3.8%，P < 0.01）。肥胖组疝气或隆起的发生率较高（10.5%对0%，P = 0.03）。33例患者返回了完整的调查问卷（回复率为30%）。与BMI相关的任何乳房Q类别均无统计学显著差异。
肥胖与显微外科乳房重建后较高的伤口并发症、再次手术和腹部隆起发生率相关。然而，患者满意度仍然较高。应向患者告知其相对风险，但高BMI不应被视为显微外科乳房重建的绝对禁忌证。
