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Achieving Patient Satisfaction in Abdominal-Based Free Flap Breast Reconstruction: Correlation With BMI Subgroups and Weight Loss
Larson K; Ozturk CN; Kundu N; Djohan R
Cleveland Clinic Foundation
2013-02-10
Presenter: Kelsey Larson, MD
Affidavit:
Director Name: Risal Djohan MD
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: The goal of this study was to evaluate the relationship between BMI, preoperative weight loss, and patient satisfaction in breast reconstruction with abdominal-based free flaps.
Patients and Methods: A custom survey with overall, breast, and abdomen subquestions was sent to patients who underwent abdominal-based free flap breast reconstruction over the last 4 years. Clinical data, including abdominal pannus thickness, was collected for patients who returned surveys. Data analysis was performed based on BMI as well as percent weight loss prior to surgery.
Results: 179 surveys were sent. 92 patients (51.4%) responded. Normal weight (BMI=20-24.9) patients versus overweight (BMI=25-29.9) patients did not have statistically significant differences in any satisfaction scores. Overweight patients had higher overall satisfaction (p=0.01), breast-specific satisfaction (p=0.01), and abdomen-specific satisfaction (p=0.02) compared to obese (BMI>30) patients. Normal weight patients had higher breast-specific satisfaction (p=0.05) and abdomen-specific satisfaction (p=0.03) scores compared to obese patients. Patients with significant preoperative weight loss (>30% total body weight) were more satisfied with feeling of breasts in clothes (p=0.01), social appearance (p=0.05) and current abdominal appearance (p=0.01) versus patients with moderate preoperative weight loss (15-30% total body weight). Overall, breast- and abdomen-specific satisfaction scores decreased with increase in pannus thickness.
Conclusion: Patient satisfaction with abdominal-based free flap breast reconstruction was highest in patients with normal BMI and lowest in obese patients. Preoperative counseling is important to ensure the postoperative results align with patient expectations. Overweight or obese patients should be encouraged to participate in healthy weight loss programs to achieve improved postoperative satisfaction.
