Effect of obesity on outcomes of free autologous breast reconstruction: a meta-analysis.

BACKGROUND: The prevalence of obesity is rising in Western society. The aim of this meta-analysis was to evaluate the available evidence regarding the effect of obesity on outcomes of free autologous breast reconstruction. METHODS: Pubmed, Ovid MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and clinicaltrials.gov were searched. Obesity was defined as a BMI ≥ 30. Comparable data from observational studies was combined for pooled analysis and quality assessment of observational studies was performed. RESULTS: Fourteen studies met the inclusion criteria (n = 6,043 patients). Pooled data analysis demonstrated significantly higher prevalences of overall complications, recipient site complications overall, donor site complications overall, donors site wound infection, donor site seroma, abdominal bulge/hernia, mastectomy skin flap necrosis, recipient site delayed wound healing, and partial flap failure, in obese (BMI ≥ 30) compared with nonobese (BMI < 30) patients. A BMI of 40 was identified as a threshold at which the prevalence of complications became prohibitively high. No randomized-controlled trials were found and all studies had methodological weaknesses. CONCLUSIONS: Complications in obese patients following free autologous breast reconstruction were higher than in their nonobese counterparts; however the majority of these complications were reported in the studies as being minor. Until better evidence is available this information will help when counseling patients.