Smoking, Obesity and Breast Reconstruction

Breast reconstruction complications more common in obese smokers

(RxWiki News) Women having a mastectomy to treat breast cancer can opt to have immediate reconstruction. These surgeries use implants to reconstruct breast tissue that was removed during the mastectomy.

In a recent study, researchers found that obesity and smoking increased the risk for having serious complications following this reconstructive surgery.

Women who smoked and were obese were up to three times more likely to lose the implant within the first 30 days than normal weight women who did’t smoke, the study found.

"Discuss all your breast reconstruction options with your surgeon."

A team of investigators led by John P. Fischer, MD, a plastic surgery resident at the Perelman School of Medicine at the Hospital of the University of Pennsylvania in Philadelphia, aimed to determine which patients were at highest risk of serious complications following breast reconstruction using implants.

Women who have mastectomies have two basic choices for surgically reconstructing the removed breast(s). One option uses implant devices and the other uses tissue from other areas of the woman’s body.

For implant-based reconstruction, a tissue expander is placed at the time the mastectomy is performed. This device is filled with saline over three to six months to stretch and prepare the skin for a permanent implant, which is put into place during a second surgery.

An alternative to this sequential method is what physicians call “direct-to-implant” surgeries where the implant is placed at the time of the mastectomy.

Rebuilding the breast(s) with the woman’s own tissue is known as autologous reconstruction. This technique uses tissue taken from the abdomen or buttocks to reshape the breast(s). This reconstruction is thought to achieve the most natural look and feel.

In this study's introduction, the authors noted that implant reconstructions are shorter operations with faster recoveries than autologous reconstruction.

“Evolving patterns of mastectomy use, along with a rising trend in immediate, bilateral breast reconstruction [reconstruction of both breasts following a double mastectomy], have solidified implant-based breast reconstruction as a standard in the United States,” the researchers wrote.

To study the risk factors associated with serious complications following implant reconstruction, Dr. Fischer and team analyzed the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) database.

These researchers analyzed data on 14,585 women between the ages of 40 and 60 who’d undergone implant-based reconstruction.

Those who had early implant removal were compared with women who had not had this complication. The authors noted that an unplanned removal of an implant within the first 30 days of surgery is a rare occurrence that happens in less than 1 percent of cases.

The researchers discovered various characteristics increased the risks of early implant removal:

  • Women over the age of 55 had a 66 percent higher chance of this complication compared with younger women.
  • Women who were classified as obese with a body mass index (BMI) of 30 to 34.9 kg/m were three times more likely to have early implant loss than women of normal weight.
  • Active smoking increased a woman's chances of complications by 295 percent.
  • Bilateral reconstruction increased the odds of serious complication by 67 percent.
  • And direct-to-implant reconstructions increased complication risks by 69 percent.

“This study demonstrated that age, obesity, smoking, bilateral procedures, and DTI reconstructions are associated with increased risk of implant loss,” the researchers concluded.

While the risk of early implant loss is rare, Dr. Fischer explained “… when we stratified patients into low-, intermediate- and high-risk groups, the risk went from 0.39 percent to 1.48 percent to 3.86 percent.” This difference may seem small, he said in a statement, but “what it means is that one in 25 patients in the high-risk group will lose a device within 30 days."

Findings from this study were published in the December issue of the Journal of the American College of Surgeons.

Review Date: 
December 5, 2013