Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
Department of Plastic and Reconstructive Surgery, University Medical Center-LCMC Health, New Orleans, Louisiana.
J Reconstr Microsurg. 2022 Jan;38(1):1-9. doi: 10.1055/s-0041-1727202. Epub 2021 Apr 14.
From both a medical and surgical perspective, obese breast cancer patients are considered to possess higher risk when undergoing autologous breast reconstruction relative to nonobese patients. However, few studies have evaluated the continuum of risk across the full range of obesity. This study sought to compare surgical risk between the three World Health Organization (WHO) classes of obesity in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction.
A retrospective review of 219 obese patients receiving 306 individual DIEP flaps was performed. Subjects were stratified into WHO obesity classes I (body mass index [BMI]: 30-34), II (BMI: 35-39), and III (BMI: ≥ 40) and assessed for risk factors and postoperative donor and recipient site complications.
When examined together, the rate of any complication between the three groups only trended toward significance ( = 0.07), and there were no significant differences among rates of specific individual complications. However, logistic regression analysis showed that class III obesity was an independent risk factor for both flap (odds ratio [OR]: 1.71, 95% confidence interval [CI]: 0.91-3.20, = 0.03) and donor site (OR: 2.34, 95% CI: 1.09-5.05, = 0.03) complications.
DIEP breast reconstruction in the obese patient is more complex for both the patient and the surgeon. Although not a contraindication to undergoing surgery, obese patients should be diligently counseled regarding potential complications and undergo preoperative optimization of health parameters. Morbidly obese (class III) patients should be approached with additional caution, and perhaps even delay major reconstruction until specific BMI goals are met.
从医学和外科角度来看，与非肥胖患者相比，肥胖乳腺癌患者在接受自体乳房重建时被认为具有更高的风险。然而，很少有研究评估过肥胖患者的风险范围。本研究旨在比较三种世界卫生组织（WHO）肥胖分类患者接受腹壁下动脉穿支皮瓣（DIEP）乳房重建时的手术风险。
对 219 名接受 306 个 DIEP 皮瓣的肥胖患者进行回顾性研究。受试者分为 WHO 肥胖 I 类（体重指数 [BMI]：30-34）、II 类（BMI：35-39）和 III 类（BMI：≥40），评估风险因素以及术后供区和受区并发症。
三组之间任何并发症的发生率仅呈趋势性差异（ = 0.07），且特定个体并发症的发生率无显著差异。然而，逻辑回归分析显示，III 类肥胖是皮瓣（比值比 [OR]：1.71，95%置信区间 [CI]：0.91-3.20， = 0.03）和供区（OR：2.34，95% CI：1.09-5.05， = 0.03）并发症的独立危险因素。
肥胖患者的 DIEP 乳房重建对患者和外科医生来说都更加复杂。虽然肥胖不是手术的禁忌症，但应向患者详细说明潜在并发症，并在术前优化健康参数。病态肥胖（III 类）患者应格外谨慎，并可能需要等待达到特定 BMI 目标后再进行主要重建。
