A systematic review on the association between body mass index and autologous breast reconstruction

Abstract

Background: The incidence of breast cancer is increasing, and the prevalence of obesity is rising. The aim of the study was to investigate the association between body mass index (BMI, kg/m2) and postoperative complications at the recipient site among women who have had autologous breast reconstruction based on free abdominal flaps. Furthermore, the aim is to investigate whether there is a BMI threshold where autologous breast reconstruction may not be recommended. Methods: Medline/PubMed and EMBASE via OVID were searched using relevant terms. The literature was assessed using the PRISMA guideline. All studies reporting recipient site complications after autologous breast reconstruction, using either deep inferior epigastric artery perforator flap, superficial inferior epigastric artery flap, muscle-sparing or free transverse rectus abdominis musculocutaneous (TRAM) flap were included. BMI was stratified according to World Health Organization (WHO) classification and furthermore defined as obese (BMI ≥30 kg/m2) and non-obese (BMI <30 kg/m2). Data regarding postoperative outcomes were combined for pooled analyses. Strengthening the reporting of observational studies in epidemiology (STROBE) statement was used for a combined quality and bias assessment. Results: Twenty studies met the inclusion criteria, encompassing a total of 10,514 patients and 11,458 flaps. Pooled analyses showed significant increased minor-and major complication rates and loss of reconstruction when compared the obese to the non-obese group. Stratifying BMI according to WHO criteria revealed significantly higher odds ratio (OR) for minor complications for all groups of obesity when compared to the normal weight group. The risk of loss of reconstruction was significantly higher in the class III obese group when compared to the normal weight. Conclusions: In the autologous breast reconstructive population, obese patients (BMI ≥30 kg/m2) have an increased risk of both minor-and major complications, as well as loss of reconstruction when compared to the non-obese population (BMI <30 kg/m2). Stratifying levels of obesity according to WHO’s BMI criteria shows increased OR for minor complications in all groups. However, autologous breast reconstruction may still be a viable option for this population. This study may be limited due to the heterogeneity of the included flaps and the quality of the included studies.