Are overweight and obese patients who receive autologous free-flap breast reconstruction satisfied with their postoperative outcome? A single-centre study.
BACKGROUND
Obese and overweight patients represent a challenging surgical group for autologous free-flap breast reconstruction. There is a paucity of information regarding post-operative patient-reported satisfaction in this increasingly prevalent cohort. This retrospective study aimed to determine using BREAST-Q patient-reported satisfaction amongst normal, overweight and obese patients receiving autologous free-flap breast reconstruction.


METHODS
BREAST-Q (post-reconstruction) module was sent to 174 autologous breast free flap reconstruction patients between 2001 and 2012. Clinical data were collated for patients who returned questionnaires. Post-operative complications and satisfaction scores were compared between normal versus overweight and obese patients.


RESULTS
A total of 101 patients (normal body mass index (BMI) = 27; overweight BMI = 48 and obese BMI = 25) completed BREAST-Q (response rate 66%). Obese and overweight patients are significantly more likely to develop major (44.8% and 31.1% vs. 29.6%) and minor (34.4% and 20% vs. 7.4%) complications in comparison to normal BMI patients (p < 0.02). Overweight and obese patients demonstrated similar levels of satisfaction compared with normal patients with the shape of their reconstructed breasts (73.2 and 72.1 vs. 71.2; p > 0.05) and overall surgical outcome (75.8 and 78.9 vs. 75.4; p > 0.05).


CONCLUSIONS
Patient post-operative satisfaction is gaining increasing relevance in assessing the outcomes from autologous breast reconstruction. Overweight and obese women benefit from autologous breast reconstruction, despite being at increased risk of post-operative complications, and eventually achieve comparable levels of post-operative satisfaction. This should be reflected in pre-operative counselling.
Department of Plastic, Reconstructive and Hand Surgery, St. Vincent's Hospital, Melbourne, Australia. Electronic address: shibasinha@gmail.com.
Shiba
S
Sinha
Department of Plastic, Reconstructive and Hand Surgery, St. Vincent's Hospital, Melbourne, Australia.
Olivia
O
Ruskin
Department of Medicine and Surgery, University of Melbourne, Melbourne, Australia; Department of Plastic and Reconstructive Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
Antonietta
A
D'Angelo
Department of Plastic, Reconstructive and Hand Surgery, St. Vincent's Hospital, Melbourne, Australia; Department of Plastic and Reconstructive Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
David
D
McCombe
Department of Plastic, Reconstructive and Hand Surgery, St. Vincent's Hospital, Melbourne, Australia; O'Brien Institute, Melbourne, Australia; Department of Surgery, St. Vincent's Hospital, Melbourne, University of Melbourne, Australia; Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia.
Wayne A J
WA
Morrison
Department of Plastic, Reconstructive and Hand Surgery, St. Vincent's Hospital, Melbourne, Australia; Department of Plastic and Reconstructive Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
Angela
A
Webb
D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D009765:Obesity / Q000150:complications*; D050177:Overweight; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014182:Transplantation, Autologous; D016896:Treatment Outcome
BREAST-Q; Breast reconstruction; Free flap; Obesity; Patient satisfaction