The impact of obesity on patient satisfaction with breast reconstruction.
BACKGROUND
As the U.S. population becomes increasingly overweight, a growing number of patients with body mass indexes greater than 30 are seeking mastectomy reconstruction. The authors' purpose was to prospectively evaluate the effect of body mass index on patient satisfaction with breast reconstruction.


METHODS
Women undergoing first-time breast reconstruction at one of 12 centers in the United States and Canada were surveyed preoperatively and at postoperative year 1. Satisfaction was evaluated with two scales assessing general and aesthetic satisfaction. Using Centers for Disease Control and Prevention criteria, patients were classified as normal weight, overweight, or obese. Logistic regressions evaluated the effects of body mass index on patient satisfaction with expander/implant, pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, and free TRAM flap techniques while controlling for patient age and timing of reconstruction.


RESULTS
Data were available for a total of 262 patients. Patient body mass index had a significant effect on aesthetic satisfaction, particularly among patients undergoing expander/implant procedures. Compared with normal weight individuals, obese patients with expander/implants were significantly less satisfied aesthetically (odds ratio, 0.14, p = 0.02). However, there was no significant difference between obese and normal weight patients in aesthetic satisfaction with TRAM flap reconstruction. Finally, body mass index had no significant effects on general satisfaction for either expander/implant or TRAM flap technique.


CONCLUSIONS
Although previous investigators have reported relatively high complication rates and modest aesthetic results for breast reconstruction in overweight and obese women, the authors' study suggests that patient satisfaction with reconstruction is surprisingly high in this population, particularly in cases of autogenous tissue reconstruction.
Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical Center; Department of Surgery, St. Joseph Mercy Hospital; and Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Health Care System.
Dunya M
DM
Atisha
Amy K
AK
Alderman
Latoya E
LE
Kuhn
Edwin G
EG
Wilkins
D000328:Adult; D015992:Body Mass Index; D004954:Esthetics; D005260:Female; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome