Abstract
Background Increased rates of both breast cancer and obesity have resulted in more obese women
seeking breast reconstruction. Studies demonstrate that these women are at increased
risk for perioperative complications. A systematic review was conducted to assess
the outcomes in obese women who underwent breast reconstruction following mastectomy.
Methods Cochrane, PUBMED, and EMBASE electronic databases were screened and data were extracted
from included studies. The clinical outcomes assessed were surgical complications,
medical complications, length of postoperative hospital stay, reoperation rate, and
patient satisfaction.
Results Out of 33 studies met the inclusion criteria for the review and 29 provided enough
data to be included in the meta-analysis (71,368 patients, 20,061 of whom were obese).
Obese women (body mass index > 30 kg/m2) were 2.29 times more likely to experience surgical complications (95% confidence
interval (CI) 2.19–2.39; p < 0.00001), 2.89 times more likely to have medical complications (95% CI 2.50–3.35;
p < 0.00001), and had a 1.91 times higher risk of reoperation (95% CI 1.75–2.07; p < 0.00001). The most common complication, wound dehiscence, was 2.51 times more likely
in obese women (95% CI 1.80–3.52; p < 0.00001). Sensitivity analysis confirmed that obese women were more likely to experience
surgical complications (risk ratio 2.36, 95% CI 2.22–2.52; p < 0.00001).
Conclusions This study provides evidence that obesity increases the risk of complications in
both implant-based and autologous reconstruction. Additional prospective and observational
studies are needed to determine if the weight reduction prior to reconstruction reduces
the perioperative risks associated with obesity.
Keywords
plastic surgery - breast reconstruction - obesity - breast surgery complication -
breast cancer
