Microsurgical Breast Reconstruction in the Obese
| Autor: | Kristen A Klement, John B. Hijjawi, Pamela Omesiete-Adejare, John A LoGiudice, Mohammad Alghoul |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Microsurgery medicine.medical_specialty Mammaplasty Breast surgery medicine.medical_treatment Population Breast Neoplasms 030230 surgery Surgical Flaps Necrosis 03 medical and health sciences 0302 clinical medicine Patient satisfaction Breast cancer Humans Medicine Obesity education Mastectomy Aged Retrospective Studies education.field_of_study business.industry Retrospective cohort study Middle Aged medicine.disease Surgery Exact test Patient Satisfaction 030220 oncology & carcinogenesis Female business Breast reconstruction |
| Zdroj: | Plastic and Reconstructive Surgery. 144:539-546 |
| ISSN: | 0032-1052 |
| DOI: | 10.1097/prs.0000000000005897 |
| Popis: | BACKGROUND Obesity has reached epidemic proportions, with 72 million people in the United States classified as obese in 2010. This significant increase in obese patients is reflected in the breast cancer population seeking breast reconstruction. Previous studies demonstrated increased complication rates and decreased satisfaction in obese patients undergoing breast reconstruction. This study aims to directly compare prosthetic and autologous reconstruction in the obese population by evaluating surgical outcomes and patient satisfaction. METHODS In an institutional review board-approved study, a retrospective chart review was conducted on patients with a body mass index of 30.0 kg/m or greater who underwent breast cancer reconstruction after mastectomy with either free tissue transfer from the abdomen or prosthetic reconstruction over a 3-year period. The authors identified 96 patients with 141 reconstructions. Demographic, intraoperative, and postoperative variables were collected. All patients were sent the BREAST-Q questionnaire by means of mail to study the impact and effectiveness of breast surgery from the patient's perspective. Statistical analysis was completed with Fisher's exact test, Mantel-Haenszel chi-square test, Pearson chi square test, or Mann-Whitney-Wilcoxon test. RESULTS Prosthetic-based breast reconstruction was associated with increased major breast complications (p < 0.001), mastectomy skin flap necrosis (p = 0.009), infection (0.006), and overall reconstructive failure (p < 0.0001) compared with autologous reconstruction. When evaluating the results of the BREAST-Q studies, the autologous reconstruction group had improved satisfaction with breasts (p < 0.0001), satisfaction with outcome (p = 0.01), psychosocial well-being (p = 0.007), and sexual well-being (p = 0.006). CONCLUSION In the obese population, reconstruction with free tissue transfer from the abdomen resulted in decreased complications of the breast reconstruction site and improved patient satisfaction with outcomes compared with prosthetic reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III. |
| Databáze: | OpenAIRE |
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