The Effect of Obesity on Post-operative Body Image in Women Undergoing Breast Reconstruction

Kulkarni AR, Atisha D, Alderman AK, Wilkins EG  

Purpose

Previous research by our group and others has shown that breast reconstruction after mastectomy confers significant psychosocial benefits to patients.  However, previous reports have also demonstrated relatively high complication rates in overweight and obese patients undergoing these procedures.  Despite the rising prevalence of obesity in America, many plastic surgeons have expressed reluctance to offer breast reconstruction to these patients due to potential for complications.  We sought to evaluate the impact of breast reconstruction on post-operative body image in overweight and obese patients.

Methods and Materials

Women undergoing first-time breast reconstruction at 12 centers by 23 plastic surgeons were prospectively evaluated.  Pre-operatively and at 1 year postoperatively, study participants completed a questionnaire detailing health status information.  The post-operative questionnaire included a subscale of 9 questions assessing body image.  Patients were asked to respond to each item using a 5-point Likert scale.  A final body image score was calculated with a range from 5 (lowest body image) to 45 (highest body image).  Based on Centers for Disease Control criteria, patients were classified as normal weight (BMI <25), overweight (BMI= 25-30), or obese (BMI>30).  Each BMI category was evaluated for differences in pre and post-operative body image scores with ANOVA single-factor analysis.  Logistic regressions were used to analyze the effects of BMI category, age, timing of surgery (immediate vs. delayed), type of reconstruction (implant vs autogenous), and pre-operative body image scores on post-operative body image scores. 

Results

Our study population included 198 post-mastectomy patients.  Pre-operatively, there was a significant difference between the body image scores of normal women when compared to overweight and obese women.  Overweight women rated their pre-operative body image 11% lower than normal women (p=0.01), while obese women rated their body image 22% lower than normal women (p=0.0002).  One year after undergoing breast reconstruction, all patient cohorts experienced an improvement in body image scores.  However, postoperatively there were no statistically significant differences between normal, overweight, and obese women (p=0.5).  Logistic regression analysis showed that patient BMI had no significant effect on post-operative body image scores.  Significant effects on post-operative body image were noted for patient age, timing of surgery (immediate vs. delayed), and pre-operative body image scores.

Conclusions

Obesity does not appear to limit improvements in body image offered by post-mastectomy breast reconstruction.  In our analysis, overweight and obese patients reported postoperative body image scores on par with normal weight women, representing a marked improvement from pre-operative status.  Despite the higher surgical complication rates among obese patients, surgeons should be aware of the benefits of breast reconstruction in this population and use these data for informed patient decision-making.