Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK, USA.
Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University, Nashville, TN, USA.
J Plast Reconstr Aesthet Surg. 2022 Dec;75(12):4496-4512. doi: 10.1016/j.bjps.2022.10.009. Epub 2022 Oct 11.
Obesity is a risk factor for breast cancer and may affect the incidence, and outcomes of surgical treatment for breast cancer, including breast reconstruction.
This study aimed to evaluate outcomes of breast reconstruction in patients with obesity.
In a retrospective review of the NSQIP 2013-2018, adult patients who underwent breast reconstruction were included. Procedures were categorized to with or without an implant. Obesity was considered as body mass index(BMI)≥30 kg/m. We made composite variables for 30-day any complication, wound complications, and major complications. Regression analysis was used to identify the independent effect of obesity on outcomes.
A total of 46,042 patients were included(mean age 51.4 ± 11.1 years, 99.8% female). There were 3134(6.8%) patients with any complication, 2429(5.3%) with major, and 2772(6%) with wound complications, 2795 patients(6.1%) with unplanned re-operation, and 3 deaths. Obesity was an independent predictor of any complication, major complications, and wound complications(OR:1.83-1.87), and unplanned re-operation(OR:1.52). Wound complication was lower in the implant group(3.7% vs 10.9%) but obesity had a higher odds of wound complications in the implant group(2 vs 1.4). There was an increase in the odds of complications as BMI rises.
Patients with a BMI>30 kg/m2 have a significantly higher risk of developing surgical complications following breast reconstruction with both implant and tissue reconstruction. Weight loss strategies should be considered in patients who need breast reconstruction surgeries and this may decrease the risk of postoperative wound complication and the need for reoperation.
肥胖是乳腺癌的一个风险因素，可能会影响乳腺癌的发病率和手术治疗结果，包括乳房重建。
本研究旨在评估肥胖患者乳房重建的结果。
在对 NSQIP 2013-2018 年的回顾性研究中，纳入了接受乳房重建的成年患者。手术分为有植入物和无植入物两类。肥胖定义为体重指数（BMI）≥30 kg/m2。我们为 30 天内任何并发症、伤口并发症和主要并发症创建了复合变量。回归分析用于确定肥胖对结果的独立影响。
共纳入 46042 例患者（平均年龄 51.4±11.1 岁，99.8%为女性）。有 3134 例（6.8%）患者出现任何并发症，2429 例（5.3%）出现主要并发症，2772 例（6%）出现伤口并发症，2795 例（6.1%）患者需要计划外再次手术，3 例死亡。肥胖是任何并发症、主要并发症和伤口并发症的独立预测因素（OR：1.83-1.87），也是计划外再次手术的独立预测因素（OR：1.52）。植入组的伤口并发症发生率较低（3.7% vs 10.9%），但肥胖患者在植入组的伤口并发症发生率更高（2 比 1.4）。随着 BMI 的升高，并发症的几率增加。
BMI>30 kg/m2 的患者在接受乳房重建术时，无论是使用植入物还是组织重建，发生手术并发症的风险显著增加。需要乳房重建手术的患者应考虑减肥策略，这可能降低术后伤口并发症和再次手术的风险。
