by Gabriel, Allen; Sigalove, Steven; Storm-Dickerson, Toni
L.; Sigalove, Noemi M.; Pope, Nicole; Rice, Jami; Maxwell, G. Patrick
Plastic and
Reconstructive Surgery: June 2020 -
Volume 145 - Issue 6 - p 1357-1365
Background:
Breast reconstruction in patients with a high body mass index (BMI) (≥30 kg/m2)
is technically challenging and is associated with increased postoperative
complications. The optimal reconstructive approach for these patients remains
to be determined. This study compared outcomes of prepectoral and dual-plane
reconstruction in high-BMI patients to determine whether there was an
association between postoperative complications and the plane of
reconstruction.
Methods: High-BMI
patients who underwent immediate dual-plane or prepectoral expander/implant
reconstruction were included in this retrospective study. Patients were
stratified by reconstructive approach (dual-plane or prepectoral), and
postoperative complications were compared between the groups. Multivariate
logistic regression analysis was performed to determine whether the plane of
reconstruction was an independent predictor of any complication after adjusting
for potential confounding differences in patient variables between the groups.
Results: Of 133
patients, 65 (128 breasts) underwent dual-plane and 68 (129 breasts) underwent
prepectoral reconstruction. Rates of seroma (13.3 percent versus 3.1 percent),
surgical-site infection (9.4 percent versus 2.3 percent), capsular contracture
(7.0 percent versus 0.8 percent), and any complication (25.8 percent versus
14.7 percent) were significantly higher in patients who had dual-plane versus prepectoral
reconstruction (p < 0.05). Multivariate logistic regression identified
dual-plane, diabetes, neoadjuvant radiotherapy, and adjuvant chemotherapy as
significant, independent predictors of any complication (p < 0.05).
Dual-plane reconstruction increased the odds of any complication by 3-fold
compared with the prepectoral plane.
Conclusion:
Compared with the dual-plane approach, the prepectoral approach appears to be
associated with a lower risk of postoperative complications following immediate
expander/implant breast reconstruction and may be a better reconstructive
option in high-BMI patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic,
III.
