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Tissue Expander Breast Reconstruction Risk Assessment: Does BMI Contribute To Outcomes?
Julie L. Cooper, BS1, Yash Kadakia, BA1, Austin Hembd, MD1, Ricardo Garza, BS1, Avinash Jayaraman, BA1, Sami U. Khan, MD2, Nicholas T. Haddock, MD1, Sumeet S. Teotia, MD1.
1University of Texas Southwestern Medical Center, Dallas, TX, USA, 2Stony Brook University, Stony Brook, NY, USA.

PURPOSE: A post-operative multidisciplinary approach showing improved rates of tissue expander (TE) salvage in breast reconstruction patients has been previously described. This prompted us to investigate whether BMI could contribute to TE salvage and removal frequencies in TE reconstruction patients.
METHODS: Retrospective chart review was performed on 810 patients who had tissue expanders placed by two senior surgeons at a university hospital (Dec 2009 - Dec 2018). Patients were organized into six groups based on BMI: underweight (BMI < 18.5, n = 21), normal weight (BMI 18.5-25, n = 330), overweight (BMI 25-30, n = 235), obese class I (BMI 30-35, n = 142), obese class II (BMI 35-40, n = 54), obese class III (BMI > 40, n = 28). TE removal and co-morbidities were tracked between the two groups. Data was collected using a centralized REDCap database and analyses were performed using Microsoft Excel software.
RESULTS: The proportion of TEs removed in patients with BMI > 35 (13/82) was significantly higher than the proportion of TEs removed in patients with BMI < 35 (58/728), p = 0.016. Additionally, the percentage of TEs removed among patients in a single BMI class increased in a linear fashion with increasing BMI classification such that with each increase in BMI classification, the percentage of patients that had their TEs removed increased by about 3.7% (R2=0.9285). However, the frequencies of co-morbidities between groups were not equal. Patients with BMI > 35 had a higher incidence of hypertension and of diabetes (p=0.001 and p=0.0004 respectively) compared to patients with BMI < 35.
CONCLUSION: TE reconstruction patients with BMI > 35 showed a higher percentage of TEs removed compared to patients with BMI < 35. Additionally, the percentage of TEs removed increased in a linear fashion with increasing BMI classification. Although co-morbidities differed between the two patient groups, BMI can still be used as one predictor of TE removal risk. Thus, patients with higher BMI classifications may benefit from additional post-operative precautions and appropriate pre-operative counseling to prevent complications that lead to TE removal.


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