The impact of obesity on abdominal wall function after free autologous breast reconstruction

Abstract

The functional impact of obesity on abdominal wall strength after abdominally based autologous reconstruction is unknown. The purpose of this study was to determine if obesity alters the postoperative abdominal wall strength profile after autologous reconstruction. We prospectively examined abdominal wall strength and function following autologous breast reconstruction between 2005 and 2010. Enrolled patients completed functional testing [upper abdominal strength (UA), lower abdominal strength (LA), and functional independence measure (FIM)] and psychometric testing utilizing the short form 36 (SF36). Data were obtained at preoperative, early (<90d), and late (90-365d) follow-up visits. Obese patients were compared with non-obese patients in both unilateral and bilateral reconstructions. Overall, 167 patients were enrolled, with obesity noted in 34% of patients. Obese Unilateral reconstruction patients had lower preoperative UA strength (4.7 vs.4.2, P=0.05) and FIM (6.7 vs. 6.9, P=0.008) scores compared with non-obese patients. These scores significantly worsened in all patients from preoperative to early follow-up, yet scores did not differ at late follow-up between obesity cohorts. Obese bilateral reconstruction patients had similar preoperative functional scores; however, UA strength scores at early (2.5 vs. 3.2, P=0.008) and late (3.6 vs. 4.3, P=0.005) follow-up were significantly lower compared with non-obese patients. No differences in subjective health were noted in follow-up for unilateral or bilateral reconstructions. Obesity significantly impacts the abdominal function profile of autologous breast reconstruction patients; however, subjective physical and mental health differences are less notable. This is especially true for obese patients who undergo bilateral reconstructions. In these patients, a careful balance between optimizing flap perfusion, limiting donor site morbidity, and enabling functional recovery should be considered.