Prospective Evaluation of Obese Patients Undergoing Autologous Abdominal Free Flap Breast Reconstruction

Introduction: Obesity has been viewed as a relative contraindication against autologous free flap breast reconstruction due to increased risks of complications including flap loss. Methods: Prospective analysis of obese patients undergoing autologous breast reconstruction. Results: Overall 72 patients (average age: 48.5 years; average 35.7: kg/m2) underwent abdominal free flap breast reconstruction. Forty-three patients underwent bilateral while the remainder had unilateral reconstruction (n=115 flaps). There were 67 muscle-sparing TRAM flaps (58.3%), 44 DIEP flaps (38.2%), two free bipedicle DIEP flaps, one SIEA and one free TRAM flap. Forty-two patients (58.3%) had prior radiation, and 51 (70.8%) had prior chemotherapy. Forty-three patients (59.7%) underwent delayed reconstruction versus 21 (29.2%) underwent immediate reconstruction. Eight patients (11.1%) had bilateral reconstruction with one breast reconstructed in an immediate and the other in a delayed fashion. Half the patients (n=36) had mesh placed in an underlay fashion to reinforce the donor site. Regarding breast complications, there were 11 wound dehiscences, one hematoma, one infection, and two patients with mastectomy skin flap necrosis. Twelve patients had donor site wound healing complications, four infections, and three patients developed a bulge/hernia. There were no flap losses. Comparison to historic controls demonstrated no significant differences in overall flap loss rates (p=0.061) or donor site bulge/hernia (p=0.86). Conclusions: Autologous abdominal free flaps can be performed safely in obese patients without increased risks for donor site bulge/hernia, or flap loss compared to non-obese patients; however, patients should be counseled carefully regarding the potential risks of complications. Disclosures: The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this manuscript at the time of the study. No funding was received for the work presented in this manuscript. Corresponding Author: Edward I. Chang, MD, Department of Plastic Surgery, Unit 443, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, (p) 713.794.1247, (f) 713.794.5482, Email: eichang@mdanderson.org ©2018American Society of Plastic Surgeons

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