Skip to main content
Erschienen in: Annals of Surgical Oncology 1/2021

08.09.2020 | Reconstructive Oncology

Comparisons Between Normal Body Mass Index and Overweight Patients Who Underwent Unilateral Microsurgical Breast Reconstructions

verfasst von: Ming-Huei Cheng, MD, MBA, FACS, Satomi Koide, MD, MBBS, Courtney Chen, MD, Yi-ling Lin, MSc

Erschienen in: Annals of Surgical Oncology | Ausgabe 1/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

This study compared the outcomes of unilateral microsurgical breast reconstructions using abdomen-based flaps between normal body mass index (BMI; 18.5 < BMI < 24.9 kg/m2) and overweight (25 < BMI < 29.9 kg/m2) patients.

Methods

Between March 2000 and December 2015, patients who underwent unilateral breast reconstructions using abdomen-based flaps were retrospectively evaluated. Outcomes variables evaluated included the flap-used weight, flap-used/flap-harvested percentage, flap-used/specimen percentage, complication rates, revision procedures, and quality of life using the Breast-Q questionnaires.

Results

A total of 415 patients with a mean age of 45.3 ± 8.2 years underwent 418 abdomen-based flaps. The overall success rate was 98.8%, with 99.1% and 97.9% of patients included in the normal BMI and overweight groups, respectively (p = 0.36). The mean flap-used weight and flap-used/flap-harvested values of 461 ± 132.1 g and 82.2 ± 11.6%, respectively, in the normal BMI group were statistically different from values of 610 ± 148.9 g and 71.4 ± 14.1% in the overweight group (both p < 0.01). The mean flap-used/specimen percentage was 118.5 ± 32.9 and 111.7 ± 36.6 in the normal BMI and overweight groups, respectively (p = 0.26). At a mean follow-up of 135 ± 55.4 months, there were no statistical differences between the two groups in terms of total complication rates (25.7% vs. 29.2%; p = 0.30), revision times (36.1% vs. 36.5%; p = 0.91) and all four domains (all p > 0.05) of the Breast-Q.

Conclusions

Patients with a normal BMI required a smaller flap-used weight but higher flap-used/flap-harvested percentage for unilateral microsurgical breast reconstructions that could be performed with a high success rate and comparable complication and revision rates.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Arver B, Isaksson K, Atterhem H, et al. Bilateral prophylactic mastectomy in Swedish women at high risk of breast cancer: a national survey. Ann Surg. Jun 2011;253(6):1147–1154.PubMedCrossRef Arver B, Isaksson K, Atterhem H, et al. Bilateral prophylactic mastectomy in Swedish women at high risk of breast cancer: a national survey. Ann Surg. Jun 2011;253(6):1147–1154.PubMedCrossRef
2.
Zurück zum Zitat Zendejas B, Moriarty JP, O’Byrne J, Degnim AC, Farley DR, Boughey JC. Cost-effectiveness of contralateral prophylactic mastectomy versus routine surveillance in patients with unilateral breast cancer. J Clin Oncol. Aug 2011;29(22):2993–3000.PubMedPubMedCentralCrossRef Zendejas B, Moriarty JP, O’Byrne J, Degnim AC, Farley DR, Boughey JC. Cost-effectiveness of contralateral prophylactic mastectomy versus routine surveillance in patients with unilateral breast cancer. J Clin Oncol. Aug 2011;29(22):2993–3000.PubMedPubMedCentralCrossRef
3.
Zurück zum Zitat Frost MH, Hoskin TL, Hartmann LC, Degnim AC, Johnson JL, Boughey JC. Contralateral prophylactic mastectomy: long-term consistency of satisfaction and adverse effects and the significance of informed decision-making, quality of life, and personality traits. Ann Surg Oncol. Oct 2011;18(11):3110–3116.PubMedPubMedCentralCrossRef Frost MH, Hoskin TL, Hartmann LC, Degnim AC, Johnson JL, Boughey JC. Contralateral prophylactic mastectomy: long-term consistency of satisfaction and adverse effects and the significance of informed decision-making, quality of life, and personality traits. Ann Surg Oncol. Oct 2011;18(11):3110–3116.PubMedPubMedCentralCrossRef
4.
Zurück zum Zitat Crosby MA, Garvey PB, Selber JC, et al. Reconstructive outcomes in patients undergoing contralateral prophylactic mastectomy. Plast Reconstr Surg. Nov 2011;128(5):1025–1033.PubMedCrossRef Crosby MA, Garvey PB, Selber JC, et al. Reconstructive outcomes in patients undergoing contralateral prophylactic mastectomy. Plast Reconstr Surg. Nov 2011;128(5):1025–1033.PubMedCrossRef
5.
Zurück zum Zitat Spear SL, Schwarz KA, Venturi ML, Barbosa T, Al-Attar A. Prophylactic mastectomy and reconstruction: clinical outcomes and patient satisfaction. Plast Reconstr Surg. Jul 2008;122(1):1–9.PubMedCrossRef Spear SL, Schwarz KA, Venturi ML, Barbosa T, Al-Attar A. Prophylactic mastectomy and reconstruction: clinical outcomes and patient satisfaction. Plast Reconstr Surg. Jul 2008;122(1):1–9.PubMedCrossRef
6.
Zurück zum Zitat Gurunluoglu R, Gurunluoglu A, Williams SA, Tebockhorst S. Current trends in breast reconstruction: survey of American Society of Plastic Surgeons 2010. Ann Plast Surg. Jan 2013;70(1):103–110.PubMedCrossRef Gurunluoglu R, Gurunluoglu A, Williams SA, Tebockhorst S. Current trends in breast reconstruction: survey of American Society of Plastic Surgeons 2010. Ann Plast Surg. Jan 2013;70(1):103–110.PubMedCrossRef
7.
Zurück zum Zitat Albornoz CR, Bach PB, Pusic AL, et al. The influence of sociodemographic factors and hospital characteristics on the method of breast reconstruction, including microsurgery: a U.S. population-based study. Plast Reconstr Surg. May 2012;129(5):1071–1079. Albornoz CR, Bach PB, Pusic AL, et al. The influence of sociodemographic factors and hospital characteristics on the method of breast reconstruction, including microsurgery: a U.S. population-based study. Plast Reconstr Surg. May 2012;129(5):1071–1079.
8.
Zurück zum Zitat Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg. 2013;131(1):15–23. Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg. 2013;131(1):15–23.
9.
Zurück zum Zitat Tanna N, Broer PN, Weichman KE, et al. Microsurgical breast reconstruction for nipple-sparing mastectomy. Plast Reconstr Surg. Feb 2013;131(2):139e–147e.PubMedCrossRef Tanna N, Broer PN, Weichman KE, et al. Microsurgical breast reconstruction for nipple-sparing mastectomy. Plast Reconstr Surg. Feb 2013;131(2):139e–147e.PubMedCrossRef
10.
Zurück zum Zitat Tanna N, Clayton JL, Roostaeian J, Perry AD, Crisera CA. The volume-outcome relationship for immediate breast reconstruction. Plast Reconstr Surg. Jan 2012;129(1):19–24.PubMedCrossRef Tanna N, Clayton JL, Roostaeian J, Perry AD, Crisera CA. The volume-outcome relationship for immediate breast reconstruction. Plast Reconstr Surg. Jan 2012;129(1):19–24.PubMedCrossRef
11.
Zurück zum Zitat Vega SJ, Bossert RP, Serletti JM. Improving outcomes in bilateral breast reconstruction using autogenous tissue. Ann Plast Surg. May 2006;56(5):487–490; discussion 490-481. Vega SJ, Bossert RP, Serletti JM. Improving outcomes in bilateral breast reconstruction using autogenous tissue. Ann Plast Surg. May 2006;56(5):487–490; discussion 490-481.
12.
Zurück zum Zitat Venkat R, Lee JC, Rad AN, Manahan MA, Rosson GD. Bilateral autologous breast reconstruction with deep inferior epigastric artery perforator flaps: Review of a single surgeon’s early experience. Microsurgery. May 2012;32(4):275–280.PubMedCrossRef Venkat R, Lee JC, Rad AN, Manahan MA, Rosson GD. Bilateral autologous breast reconstruction with deep inferior epigastric artery perforator flaps: Review of a single surgeon’s early experience. Microsurgery. May 2012;32(4):275–280.PubMedCrossRef
13.
Zurück zum Zitat Martinez CA, Walters JA, 3rd, Sato EA, Hall JJ, Boutros SG. Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in Patients With Previous Bariatric Surgery: Is It Safe and Feasible? Ann Plast Surg. Feb 2016;76(2):216–220.PubMedCrossRef Martinez CA, Walters JA, 3rd, Sato EA, Hall JJ, Boutros SG. Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in Patients With Previous Bariatric Surgery: Is It Safe and Feasible? Ann Plast Surg. Feb 2016;76(2):216–220.PubMedCrossRef
14.
Zurück zum Zitat Cheng MH, Robles JA, Ulusal BG, Wei FC. Reliability of zone IV in the deep inferior epigastric perforator flap: a single center’s experience with 74 cases. Breast. Apr 2006;15(2):158–166.PubMedCrossRef Cheng MH, Robles JA, Ulusal BG, Wei FC. Reliability of zone IV in the deep inferior epigastric perforator flap: a single center’s experience with 74 cases. Breast. Apr 2006;15(2):158–166.PubMedCrossRef
15.
Zurück zum Zitat Ali R, Bernier C, Lin YT, et al. Surgical strategies to salvage the venous compromised deep inferior epigastric perforator flap. Ann Plast Surg. Oct 2010;65(4):398–406.PubMedCrossRef Ali R, Bernier C, Lin YT, et al. Surgical strategies to salvage the venous compromised deep inferior epigastric perforator flap. Ann Plast Surg. Oct 2010;65(4):398–406.PubMedCrossRef
16.
Zurück zum Zitat Patel NG, Rozen WM, Chow WT, et al. Stacked and bipedicled abdominal free flaps for breast reconstruction: considerations for shaping. Gland Surg. Apr 2016;5(2):115–121.PubMedPubMedCentral Patel NG, Rozen WM, Chow WT, et al. Stacked and bipedicled abdominal free flaps for breast reconstruction: considerations for shaping. Gland Surg. Apr 2016;5(2):115–121.PubMedPubMedCentral
17.
Zurück zum Zitat DellaCroce FJ, Sullivan SK, Trahan C. Stacked deep inferior epigastric perforator flap breast reconstruction: a review of 110 flaps in 55 cases over 3 years. Plast Reconstr Surg. Mar 2011;127(3):1093–1099.PubMedCrossRef DellaCroce FJ, Sullivan SK, Trahan C. Stacked deep inferior epigastric perforator flap breast reconstruction: a review of 110 flaps in 55 cases over 3 years. Plast Reconstr Surg. Mar 2011;127(3):1093–1099.PubMedCrossRef
18.
Zurück zum Zitat Mayo JL, Allen RJ, Sadeghi A. Four-flap Breast Reconstruction: Bilateral Stacked DIEP and PAP Flaps. Plast Reconstr Surg Glob Open. May 2015;3(5):e383.PubMedPubMedCentralCrossRef Mayo JL, Allen RJ, Sadeghi A. Four-flap Breast Reconstruction: Bilateral Stacked DIEP and PAP Flaps. Plast Reconstr Surg Glob Open. May 2015;3(5):e383.PubMedPubMedCentralCrossRef
19.
Zurück zum Zitat Beugels J, Vasile JV, Tuinder SMH, et al. The Stacked Hemiabdominal Extended Perforator Flap for Autologous Breast Reconstruction. Plast Reconstr Surg. Dec 2018;142(6):1424–1434.PubMedCrossRef Beugels J, Vasile JV, Tuinder SMH, et al. The Stacked Hemiabdominal Extended Perforator Flap for Autologous Breast Reconstruction. Plast Reconstr Surg. Dec 2018;142(6):1424–1434.PubMedCrossRef
20.
Zurück zum Zitat Haddock NT, Cho MJ, Teotia SS. Comparative Analysis of Single versus Stacked Free Flap Breast Reconstruction: A Single-Center Experience. Plast Reconstr Surg. Sep 2019;144(3):369e–377e.PubMedCrossRef Haddock NT, Cho MJ, Teotia SS. Comparative Analysis of Single versus Stacked Free Flap Breast Reconstruction: A Single-Center Experience. Plast Reconstr Surg. Sep 2019;144(3):369e–377e.PubMedCrossRef
21.
Zurück zum Zitat Huang JJ, Wu CW, Allen RJ, Jr., Shen SC, Yu CC, Cheng MH. Routine sampling of internal mammary lymph nodes during microsurgical breast reconstruction-Experience based on 524 microsurgical breast reconstructions. J Surg Oncol. Aug 2016;114(2):133–139.PubMedCrossRef Huang JJ, Wu CW, Allen RJ, Jr., Shen SC, Yu CC, Cheng MH. Routine sampling of internal mammary lymph nodes during microsurgical breast reconstruction-Experience based on 524 microsurgical breast reconstructions. J Surg Oncol. Aug 2016;114(2):133–139.PubMedCrossRef
22.
Zurück zum Zitat Ho OA, Lin YL, Pappalardo M, Cheng MH. Nipple-sparing mastectomy and breast reconstruction with a deep inferior epigastric perforator flap using thoracodorsal recipient vessels and a low lateral incision. J Surg Oncol. Sep 2018;118(4):621–629.PubMedCrossRef Ho OA, Lin YL, Pappalardo M, Cheng MH. Nipple-sparing mastectomy and breast reconstruction with a deep inferior epigastric perforator flap using thoracodorsal recipient vessels and a low lateral incision. J Surg Oncol. Sep 2018;118(4):621–629.PubMedCrossRef
23.
Zurück zum Zitat Ulusal BG, Cheng MH, Wei FC, Ho-Asjoe M, Song D. Breast reconstruction using the entire transverse abdominal adipocutaneous flap based on unilateral superficial or deep inferior epigastric vessels. Plast Reconstr Surg. Apr 15 2006;117(5):1395–1403; discussion 1404-1396. Ulusal BG, Cheng MH, Wei FC, Ho-Asjoe M, Song D. Breast reconstruction using the entire transverse abdominal adipocutaneous flap based on unilateral superficial or deep inferior epigastric vessels. Plast Reconstr Surg. Apr 15 2006;117(5):1395–1403; discussion 1404-1396.
24.
Zurück zum Zitat Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. Jan 1994;32(1):32–38.PubMedCrossRef Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. Jan 1994;32(1):32–38.PubMedCrossRef
25.
Zurück zum Zitat Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg. Mar 1999;52(2):104–111.PubMedCrossRef Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg. Mar 1999;52(2):104–111.PubMedCrossRef
26.
Zurück zum Zitat Hamdi M, Weiler-Mithoff EM, Webster MH. Deep inferior epigastric perforator flap in breast reconstruction: experience with the first 50 flaps. Plast Reconstr Surg. Jan 1999;103(1):86–95.PubMedCrossRef Hamdi M, Weiler-Mithoff EM, Webster MH. Deep inferior epigastric perforator flap in breast reconstruction: experience with the first 50 flaps. Plast Reconstr Surg. Jan 1999;103(1):86–95.PubMedCrossRef
27.
Zurück zum Zitat Kroll SS. Fat necrosis in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg. Sep 2000;106(3):576–583.PubMedCrossRef Kroll SS. Fat necrosis in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg. Sep 2000;106(3):576–583.PubMedCrossRef
28.
Zurück zum Zitat Gill PS, Hunt JP, Guerra AB, et al. A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg. Apr 2004;113(4):1153–1160.PubMedCrossRef Gill PS, Hunt JP, Guerra AB, et al. A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg. Apr 2004;113(4):1153–1160.PubMedCrossRef
29.
Zurück zum Zitat Drazan L, Vesely J, Hyza P, et al. Bilateral breast reconstruction with DIEP flaps: 4 years’ experience. J Plast Reconstr Aesthet Surg. Nov 2008;61(11):1309–1315.PubMedCrossRef Drazan L, Vesely J, Hyza P, et al. Bilateral breast reconstruction with DIEP flaps: 4 years’ experience. J Plast Reconstr Aesthet Surg. Nov 2008;61(11):1309–1315.PubMedCrossRef
30.
Zurück zum Zitat Ochoa O, Chrysopoulo M, Nastala C, Ledoux P, Pisano S. Abdominal wall stability and flap complications after deep inferior epigastric perforator flap breast reconstruction: does body mass index make a difference? Analysis of 418 patients and 639 flaps. Plast Reconstr Surg. Jul 2012;130(1):21e–33e.PubMedCrossRef Ochoa O, Chrysopoulo M, Nastala C, Ledoux P, Pisano S. Abdominal wall stability and flap complications after deep inferior epigastric perforator flap breast reconstruction: does body mass index make a difference? Analysis of 418 patients and 639 flaps. Plast Reconstr Surg. Jul 2012;130(1):21e–33e.PubMedCrossRef
31.
Zurück zum Zitat Erdmann-Sager J, Wilkins EG, Pusic AL, et al. Complications and Patient-Reported Outcomes after Abdominally Based Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. Plast Reconstr Surg. Feb 2018;141(2):271–281.PubMedPubMedCentralCrossRef Erdmann-Sager J, Wilkins EG, Pusic AL, et al. Complications and Patient-Reported Outcomes after Abdominally Based Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. Plast Reconstr Surg. Feb 2018;141(2):271–281.PubMedPubMedCentralCrossRef
32.
Zurück zum Zitat Selber JC, Fosnot J, Nelson J, et al. A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: Part II. Bilateral reconstruction. Plast Reconstr Surg. Nov 2010;126(5):1438–1453. Selber JC, Fosnot J, Nelson J, et al. A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: Part II. Bilateral reconstruction. Plast Reconstr Surg. Nov 2010;126(5):1438–1453.
Metadaten
Titel
Comparisons Between Normal Body Mass Index and Overweight Patients Who Underwent Unilateral Microsurgical Breast Reconstructions
verfasst von
Ming-Huei Cheng, MD, MBA, FACS
Satomi Koide, MD, MBBS
Courtney Chen, MD
Yi-ling Lin, MSc
Publikationsdatum
08.09.2020
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 1/2021
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-09076-3

Weitere Artikel der Ausgabe 1/2021

Annals of Surgical Oncology 1/2021 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.