BMI is known to have an effect on complication rates. It isn’t fair, but it is real, and has been proven over and over in studies. There is a cut off for BMI at my surgical center. As most of the surgery I do is elective (I don’t do breast cancer reconstruction anymore), there is every incentive to lose weight prior to surgery for better outcomes and less risk. Given the explosion of semaglutide and tirazepide, weight loss is now achievable without major surgery, and the health benefits for those with BMIs over 30 are well established.
March 2024 issue of Plastic and Reconstructive Surgery had an article, “Relationship between BMI and Outcomes in Microvascular Abdominally Based Autologous Breast Reconstruction.” This is looking at breast cancer reconstruction where they essentially do a tummy tuck and use the abdominal flap via microvascular hook ups to reconstruct the breast.
They looked at 365 patients, stratified into five BMI categories: 25, up to 30, up to 35, up to 40, and greater than 40.1. They did this to try to see if there is an ideal cut off point for BMI where they should not offer free flap reconstruction using the abdominal flap.
What did they find?
Yes. There is a place to do the cutoff. To lower breast complications, cut off is BMI 32.7. To lower abdominal cutoffs the BMI cut off was 30.0
They found there were distinct levels of complication increases:
- BMI 30 any breast complication
- BMI 35 unplanned reoperation
- BMI 40 fat necrosis
- BMI 35 unplanned reoperation for wound breakdown
- BMI 30 any infection
- BMI 25 infection requiring oral antibiotics
- BMI 35 infection requiring IV antibiotics
- BMI 35 mastectomy flap necrosis
For the abdomen, they found BMI over 30 had delayed wound healing, with BMI over 40 having wound breakdowns that required reoperation.
They stated that a BMI of over 32.7 was as predictive as current smoking for breast complications. A BMI over 30 was more predictive than age, smoking, or diabetes status for abdomen complications.
My thoughts?
Interesting. As I stated above, we have a BMI cut off at my outpatient center. I don’t do breast cancer reconstruction, and breast cancer reconstruction patients have two big surgical sites and are frequently recovering after having chemo or other issues. But I do mommy makeovers, where breast and tummy surgery are done at the same time. Seeing an increase in oral antibiotic need for those with a BMI over 25 isn’t alarming. Seeing the BMI of 30 having more issues with breasts, any infection, and delay in wound healing is concerning. The fact they conclude that a BMI over 30 was more predictive than smoking or diabetes for abdominal complications was new to me.
As I mentioned in the intro, I think that semaglutide is a gamechanger. And there are benefits cosmetically to losing the weight first- you get a better tummy tuck, a better breast lift– if you lose the weight first. If you lose the weight after, you will loosen up the lift and tightening.
*In the review of this article they did state that even though autologous complications for those with higher BMIs is high, it is lower than doing implant reconstruction.