Do You Recommend Breast Reconstruction Surgery Immediately Right After a Mastectomy in Obese Patients? I Am 258 Lbs., 5' 8".

Stomach is waayy out of shape. My BMI is 38.

Doctor Answers 6

Immediate Breast Reconstruction in Obese patients

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The breast reconstruction expert in our practice prefers and performs immediate reconstruction using either the patient's own tissue or expanders/implants on all types of body habitus.  Obesity alone isn't an absolute contraindication for her to perform immediate breast reconstruction on her patients.  However, other medical conditions that tend to coexist with obesity: heart disease, diabetes, pulmonary disease, etc, may make an obese patient unable to tolerate longer surgery.  Another consideration for delaying reconstruction is the certainty or high likelihood of postmastectomy radiation.  


So if an obese patient is otherwise healthy and able to tolerate being under anesthesia for 8-10 hrs, having an abundance of abdominal tissue is a plus for using their own tissue (ie. DIEP flaps) for immediate breast reconstruction.  In fact, a study out of New Orleans, LA (A 10-year retrospective review of 758 DIEP flaps for breast reconstruction.  Plastic and reconstructive surgery [0032-1052] Gill, Paul yr:2004 vol:113 iss:4 pg:1153 -1160) found that obesity is not a risk factor for ANY complicatons.  But radiation, smoking and high blood pressure do increase the risks of complications. 


Only your multidisciplinary team of doctors (breast surgeon, plastic surgeon, radiation oncologist and oncologist) working together in evaluating your specific health and cancer status can determine which operative and reconstructive plan is best for you.

Can obese patients have DIEP flaps?

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Yes you can have breast reconstruction if you are obese.  You should be seen aevaluated for your appropriateness for reconstruction.  My preference would be for using your own tissue.  In particular the DIEP flap from the lower abdomen has been used successfully.  I use this flap especially in cases of obese patients and patients with a smoking history.  Although there can be wound healing tissues I am more comfortable caring for them in patients without implants.  Each case should be evaluated independently for other factors as well.

Immediate Breast Reconstruction in Obese Patients?

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This is a very difficult scenario that I have found myself in many times. It is very clear that obesity increases wound healing and other complications. I have had many patients do just fine even though they are obese but I have had many obese patients who have had wound healing problems as well. A part of this equation that nobody is talking about here is how good your general surgeon is as well. To a large degree this is a mutual relationship that a general surgeon and plastic surgeon need to be on the same page. If your breast flaps are too thin you risk having poor blood supply to your skin and in that case i would not reconstruct you immediately. If the breast flaps are thicker and appear to have good blood supply I would consider immediate reconstruction. Being that said I work with many excellent general surgeons and despite leaving wonderful skin flaps I still have patients with wound healing problems that are in the obese category with high BMI more than 30-35. In this day and age there is a device out that I have found very useful to make this decision at the time of surgery. It is a machine made by Life Cell corporation called the Spy machine. This device allows surgeons to look at your skin flaps on the operating table while you are asleep and assess the blood supply. I work at a hospital that has this very expensive machine and use it on every case. I have found it to be a very reliable tool to either trim skin flaps on the operating table where the blood supply looks no good and then proceed with reconstruction, or abort reconstruction because the skin flaps just do not look like they have good blood supply at all. If your surgeons do not have access to this machine then you need to leave this up to the experience and knowledge of your plastic surgeon to decide. Before I had this device at my disposal I would delay a patient like yourself because I have been burned too many times. Dr. Rhee who I know very well and is an excellent surgeon has also presented you with what I feel to be a very plausible scenario. He is an excellent and smart surgeon and so I think he makes an excellent case for proceeding.

Do You Recommend Breast Reconstruction Surgery Immediately Right After a Mastectomy in Obese Patients?

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As has been stated previously, obesity increases the risk of surgery.  I would not expect you to be a candidate for immediate autologous tissue reconstruction given your body habitus, but that would be a decision between yourself and your surgeon.


Personally, I believe that there is some utility in your circumstance in trying to save as much native skin as possible after your mastectomy.  Typically, there is an abundance of skin in this scenario, with a larger, ptotic breast.  If that description fits you, I would perform an immediate placement of a submuscular, sub-Alloderm tissue expander in conjunction with a skin sparing mastectomy.  If there is enough skin, the expander can be inflated to near complete fill and essentially used as a spacer until definitive reconstruction can take place.  This would hold your soft tissues in a more natural shape during initial healing.  If you end up needing radiation, the expander can be deflated temporarily to provide a flat chest for irradiation.

Do You Recommend Breast Reconstruction Surgery Immediately Right After a Mastectomy in Obese Patients? I Am 258 Lbs., 5' 8".

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Obesity is a risk factor.However you would need to be assessed at surgery.If you are left with healthy flaps , good  intact  muscle you could have expander reconstruction done .The expander could be left virtually empty so that there is no added stress to the incision.

If tissues are not optimal I would simply perform a good closure and do delayed reconstruction several months later

Immediate Breast Reconstruction in Obese Patients

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As a rule, I would usually recommend an immediate reconstruction over a delayed, but there are a couple of circumstances when I advise people to have a delayed reconstruction - and this is one of them.  Breast reconstruction is a major undertaking and your risk of complications is higher with a higher BMI.


My normal cut off for surgery is a BMI of 30, although I am flexible when it comes to an immediate reconstruction.  Having said that, I feel that a BMI of 38 is too high and I think that I would advise you to have a delayed reconstruction.  There is no substitute for a consultation with a breast reconstruction surgeon as it can be a very subjective process.  Good luck.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.