Autologous Breast Reconstruction an Option After Massive Weight Loss, But May Pose Extra Risks

August 30, 2023
American Society of Plastic Surgeons (ASPS)

Higher complication rate compared to patients without weight loss, reports study

Autologous breast reconstruction using the patient's own tissues can be successfully completed in women with a history of massive weight loss (MWL), but carries additional risks of complications and repeat surgery compared to patients without previous weight loss, reports a study in the September issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"Our study found that autologous breast reconstruction in patients with a history of bariatric surgery or nonsurgical weight loss carries no increased risk of reconstructive failure, and patients have similar satisfaction with their reconstruction," said James Butterworth, MD, of University of Kansas Medical Center, Kansas City. "However, while these reconstructions are successful, patients with MWL need to be counseled about the increased risk of postoperative complications and need for revision surgery."

How does MWL affect outcomes of autologous reconstruction?

While implant-based techniques remain the most common approach to breast reconstruction after mastectomy, autologous reconstruction using the patient's own tissues is an increasingly popular alternative. Autologous reconstruction is performed using a tissue flap obtained from a donor site, most commonly from lower abdominal skin and fat.

Obesity is strongly related to breast cancer risk and has been linked to increased complication rates after autologous breast reconstruction. "With the rise of obesity and bariatric surgery, more patients with a history of MWL will be presenting for breast reconstruction," Dr. Butterworth and coauthors said. They note the need for evidence on the impact of MWL on outcomes of autologous breast reconstruction.

The researchers analyzed the outcomes of 39 women with a history of MWL who subsequently underwent autologous breast reconstruction. Twenty-one patients had undergone bariatric surgery, while the remaining 18 lost more than 50 pounds without surgery. Outcomes were compared to those of 877 non-MWL patients undergoing the same procedure.

Increased complications and reoperations, compared to women without MWL

Several types of complications were more frequent in the MWL group, including greater need for blood transfusion after surgery (25.6% versus 9.9%). Women with previous MWL also had higher rates of wound-healing complications (23.5% versus 11.7%) and surgical site infections (7.4% versus 2.2%).

Patients with history of MWL were more likely to have partial loss of tissue flaps (5.9% versus 1.6%) and delayed healing at tissue donor sites (43.6% versus 27.6%). Women with MWL were also more likely to require revision surgery to optimize reconstructive outcomes. However, no patient in the MWL group had a failed reconstruction with total flap loss.

On the standardized BREAST-Q assessment, overall patient satisfaction after breast reconstruction was similar for patients with or without a history of MWL. Women with MWL did have lower scores for psychosocial and sexual well-being, possibly reflecting body image concerns other than the breasts.

The study gives new insights into the challenges and expected outcomes of autologous reconstruction in women with MWL. "Most significantly, autologous breast reconstruction can be successfully undertaken in MWL patients, though they have an increased risk of late postoperative complications," the researchers concluded.

"Patients with a history of MWL should be offered this surgical option for reconstruction but should also be counseled on the possibility of more postoperative complications and need for revisional surgeries," Dr. Butterworth said. "It is important to note that obesity also carries increased surgical risks with all types of breast reconstruction, so surgical and nonsurgical weight loss should not be discouraged in breast cancer survivors."