title: Patterns of use and patient satisfaction with breast reconstruction among obese patients: results from a population-based study.
abstract: BACKGROUND
  The national obesity epidemic is contributing to an increased proportion of overweight and obese breast cancer patients. The authors' purpose was to determine whether patterns of use and outcomes of reconstruction differed among obese and nonobese patients.
  
  
  METHODS
  The authors performed a 5-year follow-up survey of mastectomy-treated breast cancer patients from the Los Angeles and Detroit Surveillance, Epidemiology and End Results Cancer Registries (response rate, 59 percent). Patients were divided into three body mass index categories: normal weight (body mass index<25 kg/m), overweight (25 to 30 kg/m), and obese (>30 kg/m). Outcomes of interest were receipt of reconstruction, type and timing of reconstruction, access barriers, and satisfaction. Chi-square and t tests were used for analysis. Logistic regression was used to identify predictors of autologous reconstruction.
  
  
  RESULTS
  Of 374 mastectomy-treated patients, receipt of reconstruction did not vary by body mass index (53 percent normal weight, 48 percent overweight, and 45 percent obese; p=0.43). Receipt did vary by type of reconstruction: significantly more obese patients received transverse rectus abdominis musculocutaneous flaps compared with normal weight patients (53 percent versus 26 percent; p=0.01). No specific access barriers to reconstruction were identified. Patient satisfaction with surgical decision-making and surgical outcomes was similar across body mass index categories.
  
  
  CONCLUSIONS
  Obese compared with normal weight breast cancer patients have similar use of breast reconstruction, are more likely to receive an autologous procedure, and report similar satisfaction with surgical outcomes. Future efforts should be directed at decreasing the surgical risk in this challenging patient population.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: Ann Arbor, Mich.; Los Angeles, Calif.; New Brunswick, N.J.; and Atlanta, Ga. From the Section of Plastic Surgery, Department of Surgery, and the Department of General Medicine, Department of Internal Medicine, University of Michigan Medical Center; the Department of Preventive Medicine, Keck School of Medicine, University of Southern California; the New Jersey State Cancer Registry, Cancer Institute of New Jersey; and private practice.
authors.forename: Anita R
authors.initials: AR
authors.lastname: Kulkarni
authors.forename: Steven
authors.initials: S
authors.lastname: Katz
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.forename: John J
authors.initials: JJ
authors.lastname: Graff
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
mesh_terms: D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000150:complications / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000150:complications / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles; D016462:Mammaplasty / Q000379:methods; D008408:Mastectomy; D008824:Michigan; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries; D013524:Surgical Flaps; D011795:Surveys and Questionnaires