title: Achieving patient satisfaction in abdominally based free flap breast reconstruction: correlation with body mass index subgroups and weight loss.
abstract: BACKGROUND
  The goal of this study was to evaluate the relationship between body mass index, preoperative weight loss, and patient satisfaction in breast reconstruction with abdominally based free flaps.
  
  
  METHODS
  A custom survey with overall, breast, and abdomen questions was sent to patients who underwent abdominally based free flap breast reconstruction over the past 4 years. Clinical data were collected for patients who returned surveys. Data analysis was performed based on body mass index and percentage weight loss before surgery.
  
  
  RESULTS
  One hundred seventy-nine surveys were sent. Ninety-two patients (51.4 percent) responded. Normal weight patients versus overweight patients did not have statistically significant differences in any satisfaction scores. Overweight patients had higher overall satisfaction (p = 0.01), breast-specific satisfaction (p = 0.01), and abdomen-specific satisfaction (p = 0.02) compared with obese patients. Normal weight patients had higher breast-specific satisfaction (p = 0.05) and abdomen-specific satisfaction (p = 0.03) scores compared with obese patients. Patients with significant preoperative weight loss were more satisfied with feeling of breasts in clothes (p = 0.01), social appearance (p = 0.05), and current abdominal appearance (p = 0.01) compared with patients with moderate preoperative weight loss. Overall, breast- and abdomen-specific satisfaction scores decreased with increase in pannus thickness.
  
  
  CONCLUSIONS
  Patient satisfaction with abdominally based free flap breast reconstruction was highest in patients with normal body mass index and lowest in obese patients. Overweight or obese patients should be encouraged to participate in healthy weight loss programs to achieve improved postoperative satisfaction.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Cleveland, Ohio From the Departments of General Surgery and Plastic Surgery and the Women's Health Institute, Cleveland Clinic.
authors.forename: Kelsey E
authors.initials: KE
authors.lastname: Larson
authors.forename: Cemile Nurdan
authors.initials: CN
authors.lastname: Ozturk
authors.forename: Neilendu
authors.initials: N
authors.lastname: Kundu
authors.forename: Karen R
authors.initials: KR
authors.lastname: Cooper
authors.forename: Steven
authors.initials: S
authors.lastname: Bernard
authors.forename: Risal
authors.initials: R
authors.lastname: Djohan
mesh_terms: D000005:Abdomen; D000328:Adult; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D009765:Obesity / Q000453:epidemiology; D017060:Patient Satisfaction; D057234:Preoperative Period; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015431:Weight Loss