Autologous Breast Reconstruction an Option After Massive Weight Loss, But May Pose Extra Risks
Higher complication rate compared to patients without weight loss, reports study in Plastic and Reconstructive Surgery®
Autologous breast reconstruction using the patient's own tissues can be successfully completed in women with a history of massive weight loss (MWL) – but carries additional risks of complications and repeat surgery compared to patients without previous weight loss, reports a study in the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.
"Our study found that autologous breast reconstruction in patients with a history of bariatric surgery or nonsurgical weight loss carries no increased risk of reconstructive failure, and patients have similar satisfaction with their reconstruction" comments ASPS/ASRM Member Surgeon James Butterworth, MD, of University of Kansas Medical Center, Kansas City. "However, while these reconstructions are successful, patients with MWL need to be counseled about the increased risk of postoperative complications and need for revision surgery."
How does MWL affect outcomes of autologous reconstruction?
While implant-based techniques remain the most common approach to breast reconstruction after mastectomy, autologous reconstruction using the patient's own tissues is an increasingly popular alternative. Autologous reconstruction is performed using a tissue flap obtained from a donor site, most commonly from lower abdominal skin and fat.
Obesity is strongly related to breast cancer risk and has been linked to increased complication rates after autologous breast reconstruction. "With the rise of obesity and bariatric surgery, more patients with a history of MWL will be presenting for breast reconstruction," Dr. Butterworth and coauthors write. They note the need for evidence on the impact of MWL on outcomes of autologous breast reconstruction.
The researchers analyzed the outcomes of 39 women with a history of MWL who subsequently underwent autologous breast reconstruction. Twenty-one patients had undergone bariatric surgery, while the remaining 18 lost more than 50 pounds of weight without surgery. Outcomes were compared to those of 877 non-MWL patients undergoing the same procedure.
Increased complications and reoperations, compared to women without MWL
Several types of complications were more frequent in the MWL group, including greater need for blood transfusion after surgery: 25.6% versus 9.9%. Women with previous MWL also had higher rates of wound-healing complications, 23.5% versus 11.7%; and surgical site infections, 7.4% versus 2.2%.
Patients with history of MWL were more likely to have partial loss of tissue flaps (5.9% versus 1.6%) and delayed healing at tissue donor sites (43.6% versus 27.6%). Women with MWL were also more likely to require revision surgery to optimize reconstructive outcomes. However, no patient in the MWL group had a failed reconstruction with total flap loss.
On the standardized BREAST-Q assessment, overall patient satisfaction after breast reconstruction was similar for patients with or without a history of MWL. Women with MWL did have lower scores for psychosocial and sexual well-being – possibly reflecting body image concerns other than the breasts.
The study gives new insights into the challenges and expected outcomes of autologous reconstruction in women with MWL. "Most significantly, autologous breast reconstruction can be successfully undertaken in MWL patients, though they have an increased risk of late postoperative complications," the researchers conclude.
Dr. Butterworth adds: "Patients with a history of MWL should be offered this surgical option for reconstruction but should also be counseled on the possibility of more postoperative complications and need for revisional surgeries. It is important to note that obesity also carries increased surgical risks with all types of breast reconstruction, so surgical and nonsurgical weight loss should not be discouraged in breast cancer survivors."
Click here to read "Autologous Breast Reconstruction after Massive Weight Loss: Understanding Risks in a Growing Population"
Article: "Autologous Breast Reconstruction after Massive Weight Loss: Understanding Risks in a Growing Population" (doi: 10.1097/PRS.0000000000010318)
About Plastic and Reconstructive Surgery
For over 75 years, Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.
The American Society of Plastic Surgeons (ASPS) is the largest organization of board-certified plastic surgeons in the world. Representing more than 11,000 physician members worldwide, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 92 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
About Wolters Kluwer
Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.
Wolters Kluwer reported 2022 annual revenues of €5.5 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries and employs approximately 20,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.