Download PDF
J Reconstr Microsurg 2015; 31(01): 020-025
DOI: 10.1055/s-0034-1376398
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Microsurgical Breast Reconstruction in Thin Patients: The Impact of Low Body Mass Indices

Katie E. Weichman
1   Institute of Reconstructive Plastic Surgery, New York University, New York, New York
,
Neil Tanna
1   Institute of Reconstructive Plastic Surgery, New York University, New York, New York
,
P. Niclas Broer
1   Institute of Reconstructive Plastic Surgery, New York University, New York, New York
,
Stelios Wilson
1   Institute of Reconstructive Plastic Surgery, New York University, New York, New York
,
Hamdan Azhar
1   Institute of Reconstructive Plastic Surgery, New York University, New York, New York
,
Nolan S. Karp
1   Institute of Reconstructive Plastic Surgery, New York University, New York, New York
,
Mihye Choi
1   Institute of Reconstructive Plastic Surgery, New York University, New York, New York
,
Christina Y. Ahn
1   Institute of Reconstructive Plastic Surgery, New York University, New York, New York
,
Jamie P. Levine
1   Institute of Reconstructive Plastic Surgery, New York University, New York, New York
,
Robert J. Allen Sr.
1   Institute of Reconstructive Plastic Surgery, New York University, New York, New York
› Author Affiliations
Further Information

Publication History

25 January 2014

10 March 2014

Publication Date:
09 June 2014 (online)

   Permissions and Reprints

Abstract

Background The purpose of this investigation was to examine patients with low body mass index (BMI) regarding the feasibility to perform autologous breast reconstruction in such patients, as well as to determine optimal donor sites and evaluate outcomes accordingly.

Patients and Methods All patients undergoing microsurgical breast reconstruction were divided into three cohorts based on BMI. Group 1 included patients with BMI greater than or equal to 22 kg/m2 and was defined “low-normal BMI.” Patients with BMI 22 to 25 kg/m2 were placed in Group 2, labeled as “high-normal BMI.” Group 3, defined as “overweight,” included patients with BMI greater than 25 kg/m2, but less than 30 kg/m2. Patients were then analyzed based on demographics, breast cancer history, intraoperative details, complications, and revisionary surgeries. F-tests, chi-square goodness-of-fit tests, and Freeman–Halton extension of the Fisher exact tests were used for statistical analysis.

Results During the study period, a total of 259 reconstructions were performed. Group 1 included 30 patients (n = 49 flaps), Group 2 included 58 patients (n = 98 flaps), and Group 3 included 69 patients (n = 112 flaps). Patients undergoing nipple–areolar sparing mastectomy were more likely to be in Groups 1 (39% [n = 19]) and 2 (37% [n = 37]) as compared with Group 3 (14.2% [n = 16]) (p < 0.001) as compared with the overweight cohort. Patients with increasing BMI were more likely to undergo abdominally based free flaps as compared with alternative donor sites (Group 1 = 2.26, Group 2 = 7.9, Group 3 = 27 [p < 0.001]).

Conclusions Abdominally based free flaps are possible in the majority of patients, however alternative harvest sites have to be used more frequently in low BMI patients.

Keywords

low BMI - breast reconstruction - thin
 

  • References

  • 1 Alderman AK, Kuhn LE, Lowery JC, Wilkins EG. Does patient satisfaction with breast reconstruction change over time? Two-year results of the Michigan Breast Reconstruction Outcomes Study. J Am Coll Surg 2007; 204 (1) 7-12
    CrossrefPubMedGoogle Scholar
  • 2 Yueh JH, Slavin SA, Adesiyun T , et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg 2010; 125 (6) 1585-1595
    CrossrefPubMedGoogle Scholar
  • 3 Zhong T, McCarthy C, Min S , et al. Patient satisfaction and health-related quality of life after autologous tissue breast reconstruction: a prospective analysis of early postoperative outcomes. Cancer 2012; 118 (6) 1701-1709
    CrossrefPubMedGoogle Scholar
  • 4 Bodin F, Zink S, Lutz JC, Kadoch V, Wilk A, Bruant-Rodier C. Which breast reconstruction procedure provides the best long-term satisfaction? [in French]. Ann Chir Plast Esthet 2010; 55 (6) 547-552
    CrossrefPubMedGoogle Scholar
  • 5 Christensen BO, Overgaard J, Kettner LO, Damsgaard TE. Long-term evaluation of postmastectomy breast reconstruction. Acta Oncol 2011; 50 (7) 1053-1061
    CrossrefPubMedGoogle Scholar
  • 6 Gurunluoglu R, Gurunluoglu A, Williams SA, Tebockhorst S. Current trends in breast reconstruction: survey of American Society of Plastic Surgeons 2010. Ann Plast Surg 2013; 70 (1) 103-110
    CrossrefPubMedGoogle Scholar
  • 7 Albornoz CR, Bach PB, Pusic AL , et al. The influence of sociodemographic factors and hospital characteristics on the method of breast reconstruction, including microsurgery: a U.S. population-based study. Plast Reconstr Surg 2012; 129 (5) 1071-1079
    CrossrefPubMedGoogle Scholar
  • 8 Albornoz CR, Bach PB, Mehrara BJ , et al. A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg 2013; 131 (1) 15-23
    PubMedGoogle Scholar
  • 9 Tanna N, Broer PN, Weichman KE , et al. Microsurgical breast reconstruction for nipple-sparing mastectomy. Plast Reconstr Surg 2013; 131 (2) 139e-147e
    CrossrefPubMedGoogle Scholar
  • 10 Tanna N, Clayton JL, Roostaeian J, Perry AD, Crisera CA. The volume-outcome relationship for immediate breast reconstruction. Plast Reconstr Surg 2012; 129 (1) 19-24
    CrossrefPubMedGoogle Scholar
  • 11 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42 (6) 645-648
    CrossrefPubMedGoogle Scholar
  • 12 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32 (1) 32-38
    Google Scholar
  • 13 Blondeel PN, Boeckx WD. Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery. Br J Plast Surg 1994; 47 (7) 495-501
    Google Scholar
  • 14 Grotting JC. The free abdominoplasty flap for immediate breast reconstruction. Ann Plast Surg 1991; 27 (4) 351-354
    CrossrefPubMedGoogle Scholar
  • 15 Arnez ZM, Pogorelec D, Planinsek F, Ahcan U. Breast reconstruction by the free transverse gracilis (TUG) flap. Br J Plast Surg 2004; 57 (1) 20-26
    CrossrefPubMedGoogle Scholar
  • 16 Kind GM, Foster RD. Breast reconstruction using the lateral femoral circumflex artery perforator flap. J Reconstr Microsurg 2011; 27 (7) 427-432
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Allen RJ, Haddock NT, Ahn CY, Sadeghi A. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg 2012; 129 (1) 16e-23e
    CrossrefPubMedGoogle Scholar
  • 18 LoTempio MM, Allen RJ. Breast reconstruction with SGAP and IGAP flaps. Plast Reconstr Surg 2010; 126 (2) 393-401
    CrossrefPubMedGoogle Scholar
  • 19 Losken A, Pinell XA, Sikoro K, Yezhelyev MV, Anderson E, Carlson GW. Autologous fat grafting in secondary breast reconstruction. Ann Plast Surg 2011; 66 (5) 518-522
    CrossrefPubMedGoogle Scholar
  • 20 Chang DW, Wang B, Robb GL , et al. Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg 2000; 105 (5) 1640-1648
    CrossrefPubMedGoogle Scholar
  • 21 Garvey PB, Buchel EW, Pockaj BA, Gray RJ, Samson TD. The deep inferior epigastric perforator flap for breast reconstruction in overweight and obese patients. Plast Reconstr Surg 2005; 115 (2) 447-457
    CrossrefPubMedGoogle Scholar
  • 22 Jandali S, Nelson JA, Sonnad SS , et al. Breast reconstruction with free tissue transfer from the abdomen in the morbidly obese. Plast Reconstr Surg 2011; 127 (6) 2206-2213
    CrossrefPubMedGoogle Scholar
  • 23 Kroll SS, Netscher DT. Complications of TRAM flap breast reconstruction in obese patients. Plast Reconstr Surg 1989; 84 (6) 886-892
    CrossrefPubMedGoogle Scholar
  • 24 Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL. Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg 2006; 118 (5) 1100-1109 , discussion 1110–1111
    CrossrefPubMedGoogle Scholar
  • 25 Moran SL, Serletti JM. Outcome comparison between free and pedicled TRAM flap breast reconstruction in the obese patient. Plast Reconstr Surg 2001; 108 (7) 1954-1960 , discussion 1961–1962
    CrossrefPubMedGoogle Scholar
  • 26 Selber JC, Kurichi JE, Vega SJ, Sonnad SS, Serletti JM. Risk factors and complications in free TRAM flap breast reconstruction. Ann Plast Surg 2006; 56 (5) 492-497
    CrossrefPubMedGoogle Scholar
  • 27 Spear SL, Ducic I, Cuoco F, Taylor N. Effect of obesity on flap and donor-site complications in pedicled TRAM flap breast reconstruction. Plast Reconstr Surg 2007; 119 (3) 788-795
    CrossrefPubMedGoogle Scholar
  • 28 Flancbaum L, Choban PS. Surgical implications of obesity. Annu Rev Med 1998; 49: 215-234
    CrossrefPubMedGoogle Scholar
  • 29 Whitlock G, Lewington S, Sherliker P , et al; Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373 (9669) 1083-1096
    CrossrefPubMedGoogle Scholar
  • 30 Al-Sarraf N, Raza A, Rowley S , et al. Short-term and long-term outcome in low body mass index patients undergoing cardiac surgery. Gen Thorac Cardiovasc Surg 2009; 57 (2) 87-93
    CrossrefPubMedGoogle Scholar
  • 31 Okamura Y, Maeda A, Matsunaga K, Kanemoto H, Uesaka K. Negative impact of low body mass index on surgical outcomes after hepatectomy for hepatocellular carcinoma. J Hepatobiliary Pancreat Sci 2012; 19 (4) 449-457
    CrossrefPubMedGoogle Scholar
  • 32 Skipworth J, Foster J, Raptis D, Hughes F. The effect of preoperative weight loss and body mass index on postoperative outcome in patients with esophagogastric carcinoma. Dis Esophagus 2009; 22 (7) 559-563
    CrossrefPubMedGoogle Scholar
  • 33 Grover R, Padula WV, Van Vliet M, Ridgway EB. Comparing five alternative methods of breast reconstruction surgery: a cost-effectiveness analysis. Plast Reconstr Surg 2013; 132 (5) 709e-723e
    CrossrefPubMedGoogle Scholar
  • 34 Shaw WW. Breast reconstruction by superior gluteal microvascular free flaps without silicone implants. Plast Reconstr Surg 1983; 72 (4) 490-501
    Google Scholar
  • 35 Fujino T, Harashina T, Enomoto K. Primary breast reconstruction after a standard radical mastectomy by a free flap transfer. Case report. Plast Reconstr Surg 1976; 58 (3) 371-374
    Google Scholar
  • 36 Holmström H. The free abdominoplasty flap and its use in breast reconstruction. An experimental study and clinical case report. Scand J Plast Reconstr Surg 1979; 13 (3) 423-427
    CrossrefPubMedGoogle Scholar
  • 37 Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 1982; 69 (2) 216-225
    CrossrefPubMedGoogle Scholar
  • 38 Healy C, Allen Sr RJ. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg 2014; 30 (2) 121-125
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Granzow JW, Levine JL, Chiu ES, Allen RJ. Breast reconstruction using perforator flaps. J Surg Oncol 2006; 94 (6) 441-454
    CrossrefPubMedGoogle Scholar
  • 40 Baumeister S, Werdin F, Peek A. The sGAP flap: rare exception or second choice in autologous breast reconstruction?. J Reconstr Microsurg 2010; 26 (4) 251-258
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Granzow JW, Levine JL, Chiu ES, Allen RJ. Breast reconstruction with gluteal artery perforator flaps. J Plast Reconstr Aesthet Surg 2006; 59 (6) 614-621
    CrossrefPubMedGoogle Scholar
  • 42 Locke MB, Zhong T, Mureau MA, Hofer SO. Tug 'O' war: challenges of transverse upper gracilis (TUG) myocutaneous free flap breast reconstruction. J Plast Reconstr Aesthet Surg 2012; 65 (8) 1041-1050
    CrossrefPubMedGoogle Scholar