PURPOSE: Obese patients present a growing issue in breast reconstruction, yet objective outcomes criteria are lacking.

METHODS: A retrospective review of outcomes of breast reconstruction in obese patients (1/1/1990 to 1/1/2005). Analysis utilized stratified Body Mass Indices (BMI) (25-29.9, 30-34.9, 35-39.9, and >40) matched to normal weight patients (BMI < 24.9) by age and reconstructive plan (TRAM/DIEP flaps; LD flaps (w/ without implant), and implant only). RESULTS: BMI range in 3518 study patients was 15.2 to 59.9. Average BMI increased annually (24.2 to 26.8). Patient with a BMI >35 demonstrated increased post-operative complications in all reconstructions. Complication rates: 50% vs. 34% (TRAM); 33.3% vs. 22.5% (Implant); 40% vs. 33 %( LD); Overall 39% vs. 30.9%. In a subset of patients from 2000-2005, patient satisfaction and overall aesthetic outcome was lower in patients with a BMI >35.

CONCLUSION: Patients with a BMI >35 demonstrated significantly increased complication rates for all types of breast reconstruction. Satisfaction rates in obese patients appear lower compared to thinner patients. These data argue for delayed reconstruction after weight loss, and careful scrutiny of candidates for reconstruction in obese patients. Prospective study is warranted to develop an appropriate treatment algorithm for breast reconstruction in this patient population.