SP41. The Impact of BMI on Morbidity, Complications, and Reoperations in Autologous Breast Reconstruction: An ACS-NSQIP 2011-2022 Dataset Analysis

PURPOSE: Obesity is a known risk factor for postoperative complications in breast reconstruction, but the comparative outcomes across different autologous flap techniques remain underexplored. This study evaluates the effect of BMI on morbidity, surgical complications, medical complications, and reoperation rates in pedicled TRAM, latissimus dorsi, and free flap reconstructions using the ACS-NSQIP 2011-2022 dataset. METHODS: This retrospective cohort study included 24,041 women undergoing post-mastectomy autologous breast reconstruction, divided into obese (BMI ≥ 30 kg/m²) and non-obese (BMI < 30 kg/m²) groups. Morbidity and complications were analyzed by flap type. Logistic regression models adjusted for confounders were used to calculate the relative risk of complications. RESULTS: In 2057 pedicled TRAM reconstructions, obesity was associated with a significant increase in overall morbidity (21.4% vs. 14.6%, p<0.001), surgical complications (9.7% vs. 5.8%, p<0.001), and medical complications (9.5% vs. 3.6%, p<0.001). Free flaps (n=17,171) showed a significant rise in wound disruptions (p=0.001) and reoperation rates (20.8% vs. 12.6%, p=0.008) among obese patients. Latissimus dorsi reconstructions (n= 4, 813) had elevated overall complications but lower surgical and wound-related complications compared to other flaps. CONCLUSION: Obesity significantly impacts the risk of complications in autologous breast reconstruction, with pedicled TRAM flaps demonstrating the highest complication rates in obese patients. These findings underscore the need for tailored surgical strategies and individualized perioperative care based on BMI to mitigate risks and optimize outcomes.