Implant-based breast reconstruction has disadvantages

Nov 1 2012

By Piriya Mahendra, medwireNews Reporter

Implant-based breast reconstruction, particularly immediate reconstruction, is associated with a higher failure rate than a free flap technique in obese people, suggest researchers.

Patrick Garvey (The University of Texas, Houston, USA) and colleagues say that obese patients who require breast reconstruction should be treated with a free flap technique instead of an implant-based reconstruction, especially those with class II or III obesity (body mass index [BMI] 35.0-39.9 kg/m² and ≥40.0 kg/m², respectively).

Moreover, a delayed rather than an immediate reconstruction should be considered in obese patients who seek implant-based breast reconstruction, they report in Plastic and Reconstructive Surgery.

Garvey and team found that implant-based breast reconstruction demonstrated a significantly higher failure rate than abdominal-based free flap reconstruction, at 15.8% versus 1.5%.

Although they observed that failure rates were similar for immediate and delayed flap reconstructions, there was a trend toward more implant failures in immediate rather than delayed reconstructions (16.8 vs 5.3%). Neither of these comparisons were affected by World Health Organization obesity classification.

However, the differences between immediate implant versus immediate flap reconstruction failure rates were highest among class II obese patients, at 24.7% versus 1.3% and class III obese patients, at 25.4% versus 0.0%, compared with class I obese patients (BMI=30.0-24.9 kg/m²), at 11.7% versus 1.4%.

Overall, the rate of complications was significantly higher in the flap reconstruction group (42.3%) than the implant reconstruction group (35.9%). The higher complication rate in the flap reconstruction group was explained by a high rate of complications other than reconstruction loss, such as infection, delayed healing, and hernia.

Garvey and team analyzed a total of 990 breast reconstructions in 700 obese patients for the study. Abdominal-based free flaps were used in 548 reconstructions and implants in 442 reconstructions. The majority of the reconstructions performed were immediate (80.1%).

"We hope that the data presented will enable surgeons to optimally guide the reconstructive choices (flap versus implant and immediate versus delayed breast reconstruction) of obese patients," they say.

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