title: The advantages of free abdominal-based flaps over implants for breast reconstruction in obese patients.
abstract: BACKGROUND
  The authors hypothesized that, for obese patients, delayed abdominal-based free flap (rather than implant-based and immediate) breast reconstruction would result in fewer overall complications and reconstruction losses.
  
  
  METHODS
  The authors retrospectively analyzed consecutive implant- and abdominal-based free flap breast reconstructions performed in obese patients between 2005 and 2010 by utilizing the World Health Organization obesity classifications: class I, 30.0 to 34.9 kg/m2; class II, 35.0 to 39.9 kg/m2; and class III, ≥40 kg/m2. Primary outcome measures included flap failures and overall complications. Logistic regression analysis identified associations among patient, defect, and reconstructive characteristics and surgical outcomes.
  
  
  RESULTS
  The analysis included 990 breast reconstructions (548 flaps versus 442 implants) in 700 patients. Mean follow-up was 17 months. Age, smoking, medical illness, and body mass index greater than 37 predicted overall complications on regression analysis. Implants demonstrated a higher failure rate (15.8 percent) than flaps (1.5 percent). Although failure rates were similar for immediate and delayed flap reconstructions overall (1.3 versus 1.9 percent) and among obesity classifications, there was a trend toward more implant failures in immediate rather than delayed reconstructions (16.8 versus 5.3 percent). Differences between immediate implant versus flap reconstruction failure rates were highest among more obese patients [class II (24.7 versus 1.3 percent) and class III (25.4 versus 0 percent) compared with class I (11.7 versus 1.4 percent)].
  
  
  CONCLUSIONS
  Obese patients (particularly class II and III) experience higher failure rates with implant-based breast reconstruction, particularly immediate reconstruction. Free flap techniques or delayed implant reconstruction may be warranted in this population.
  
  
  METHODS
  Risk, II.
authors.affiliation: Houston, Texas From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Garvey
authors.forename: Mark T
authors.initials: MT
authors.lastname: Villa
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Rozanski
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Robb
authors.forename: Elisabeth K
authors.initials: EK
authors.lastname: Beahm
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D019928:Breast Implantation; D018427:Breast Implants; D015897:Comorbidity; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D009767:Obesity, Morbid / Q000453:epidemiology; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013997:Time Factors; D014945:Wound Healing