Autologous Breast Reconstruction in Massive Weight Loss Patients: Understanding Risks in a Growing Population

Massive weight loss (MWL) may have suboptimal effects on tissues used for autologous reconstruction. With the rise of obesity and bariatric surgery, more MWL patients will be presenting for breast reconstruction. We hypothesize that autologous breast reconstruction in patients with a history of MWL will have more complications and require more revisions compared to patients without a history of MWL. A retrospective review was performed on patients who underwent autologous breast reconstruction by five microsurgeons at an academic institution from 2009 to 2020. Patients with a history of bariatric surgery or >50-pound weight loss were identified and compared to non MWL patients. Analysis compared demographics, operative details, complications, revision rates, and BREAST-Q scores. Of 916 patients who underwent 1465 flaps, 39 MWL patients (4.3%) underwent 68 flaps (4.6%) and 877 non MWL patients underwent 1397 flaps. MWL patients were more likely to require blood transfusions postoperatively (p=.005). MWL patients experienced more surgical site infections (p=.02), wound healing complications of flap (p=.007) and donor sites (p=.03), and late partial flap losses (p=.03). More revisional surgeries for flap (p=.009) and donor sites (p=.01) were required. BREAST-Q scores were not statistically different for satisfaction with breasts or surgeon but were lower in MWL patients for psychosocial (p=.01) and sexual well-being (p=.04). Reconstructive surgeons should expect increased postoperative complications when performing autologous breast reconstruction in MWL patients. These patients should be counseled on the possibility of more postoperative complications and need for revisional surgeries.