title: Obese Women Experience Fewer Complications after Oncoplastic Breast Repair following Partial Mastectomy Than after Immediate Total Breast Reconstruction.
abstract: BACKGROUND
  The authors hypothesized that obese patients would experience fewer complications after oncoplastic breast reconstruction following partial mastectomy than after immediate breast reconstruction following total mastectomy.
  
  
  METHODS
  Complication rates were compared for oncoplastic breast reconstruction versus immediate breast reconstruction (with either implants or autologous tissue) in consecutive obese patients (body mass index ≥ 30 kg/m(2)) treated at a single center between January of 2005 and April of 2013. Logistic regression was used to analyze the associations between patient and surgical characteristics and postoperative outcomes.
  
  
  RESULTS
  The study included 408 patients: 131 oncoplastic breast reconstruction and 277 immediate breast reconstruction patients. Presenting breast cancer stage was similar between the two groups. Oncoplastic breast reconstruction patients were older (55 years versus 53 years; p = 0.029), more obese (average body mass index, 37 kg/m(2) versus 35 kg/m(2); p < 0.001), and had more comorbidities. Nevertheless, the oncoplastic breast reconstruction group experienced fewer major complications requiring operative management (3.8 percent versus 28.5 percent; p < 0.001), fewer complications delaying adjuvant therapy (0.8 percent versus 14.4 percent; p < 0.001), and fewer incidences of hematoma/seroma formation (3.1 percent versus 11.6 percent; p < 0.004) than the immediate total breast reconstruction group. Univariate analysis found oncoplastic breast reconstruction to be an independent protector against major complications (OR, 0.1; p < 0.001) and complications that delayed adjuvant therapy (OR, 0.05; p = 0.002).
  
  
  CONCLUSIONS
  Oncoplastic breast reconstruction likely represents a safer option than immediate total breast reconstruction following mastectomy for obese patients, particularly for patients who are superobese or present with preexisting medical comorbidities.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Houston, Texas From the Departments of Plastic Surgery and Breast Surgical Oncology, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Winnie M Y
authors.initials: WMY
authors.lastname: Tong
authors.forename: Donald P
authors.initials: DP
authors.lastname: Baumann
authors.forename: Mark T
authors.initials: MT
authors.lastname: Villa
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mittendorf
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Robb
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kronowitz
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Garvey
mesh_terms: D015992:Body Mass Index; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000453:epidemiology; D061525:Perforator Flap / Q000098:blood supply / Q000637:transplantation*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011184:Postoperative Period; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome