Whether to have implants or free flap breast reconstruction is among the many decisions women face after a mastectomy. Your weight and body mass index (BMI) may have a major impact on which procedure will be safest and most successful. Obesity is known to increase the risk of complications and implant failure in breast reconstruction.
A recent study published in Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons (ASPS), lent further weight to the theory that free flap breast reconstructions are more successful for women who are considered obese. Level of obesity and timing of reconstruction may also greatly increase implant failure rates. Other risk factors include age, smoking and other illnesses.
In the study, researchers analyzed the outcomes of reconstruction after breast cancer surgery in patients with a body mass index (BMI) of 30 or higher. While initially the overall complication rate was somewhat lower for implants, major complications leading to reconstruction failure were far more common – nearly 16 percent with breast implants compared to 1.5 percent with free flaps.
Timing of surgery is another major risk factor. While complications for the two procedures were similar for immediate versus delayed reconstructions in women with class I obesity (BMIs between 30-35) or lower, one fourth of immediate implant reconstructions failed with class II (BMI 35-40) and class III (BMI 40 or higher). Furthermore, the complication rate was even higher for those with BMI of 37s or greater.
Because of the rising obesity rate, more women will be facing reconstructive surgery. Given the psychological and physical seriousness of a failed reconstruction, consult with your physician and other healthcare professional about the best options for you, with an eye to your overall weight and general health. Chances are, if you fall into a high-BMI or other risk category, using free flap reconstruction or – if you opt for implants – delaying surgery will be the most prudent path.