Abstract P2-05-05: Associations among BMI and patient-reported body image dissatisfaction during immediate autologous breast reconstruction: A prospective longitudinal evaluation

Abstract Introduction: Cancer-related breast reconstruction is a process that can take months to years to complete, potentially impacting a patient’s psychosocial well-being. Body habitus may influence a patient’s adaptation to bodily changes resulting from breast cancer treatment, considering the association between obesity and body image dissatisfaction1. Thus, we investigated the association between body mass index (BMI) categorized as overweight or obese and patient-reported body image dissatisfaction at specific time points during immediate autologous breast reconstruction. Material and Methods: The study sample included 40 patients who were enrolled in an IRB approved study from 2011 to 2014 at The University of Texas MD Anderson Cancer Center and had completed immediate autologous (DIEP/TRAM) reconstruction. Participants completed health-related quality of life measures including Body Image Scale (BIS), Brief Symptom Inventory (BSI-18), and BREAST-Q preoperatively (baseline) and at least once postoperatively at 3, 6, 9, 18, or 18+ months after reconstruction. Given sufficient abdominal fat tissue is a prerequisite for any abdominal-based tissue reconstruction, patients with baseline BMI over 25 Kg/m2 were included. Linear mixed models were conducted to investigate the effect of baseline BMI category on BIS scores and BREAST-Q physical well-being of the abdomen scores (PWBAS) during reconstruction. Post hoc analyses were conducted when a significant interaction effect of baseline BMI category and time effect was found. Baseline age, depression score, marital status, race, and ethnicity were included as control variables. Analyses were performed using SAS 9.4 and the level of significance was set at p < 0.05. Results: There were no statistically significant changes in BMI across the study visits. Baseline age was significantly associated with BIS scores (ß = -0.31, p = 0.0072), with increased age associated with lower levels of dissatisfaction. Baseline depression was significantly associated with BIS scores (ß = 0.78, p = 0.0058), with higher baseline depression linked to greater body dissatisfaction. Marital status, race, and ethnicity were not statistically significantly associated with BIS scores. Obese patients reported statistically significant improvements in BIS postoperatively, whereas overweight patients had no statistically significant changes in BIS over time. At baseline, obese patients had significantly higher body image dissatisfaction compared to overweight patients (p = 0.0128) and continued to report higher dissatisfaction at follow-up visits, although the difference was not statistically significantly higher than overweight patients after the baseline visit. Baseline depression, marital status, age, race, and ethnicity were not statistically significantly associated with PWBAS. Both BMI groups reported high abdominal satisfaction preoperatively. However, obese patients experienced a significant decrease in abdominal satisfaction at 9 months (p = 0.0482) compared to baseline, while overweight patients saw significant decreases at 3 and 6 months (p < 0.0001). No statistically significant longitudinal differences were observed between BMI groups for PWBAS, except at 6 months, when obese patients had significantly higher abdominal satisfaction (p = 0.0167). Abdominal satisfaction improved by the final visits, yet it remained below baseline levels. Conclusion: Obese and overweight patients may benefit from additional body image counseling. Screening for depression and making appropriate referrals may be important for postoperative body image adjustment. Further, these patients can benefit from preoperative counseling about early postoperative physical changes to the abdomen. REFERENCES 1. Weinberger, N. et al., Body Dissatisfaction in Individuals with Obesity Compared to Normal Weight Individuals: A Systematic Review and Meta-Analysis. Obes Facts 9, 424–441 (2016). Citation Format: Sara Bouhali, Tzuan A. Chen, Gregory P. Reece, Mia K. Markey, Fatima A. Merchant, Deepti Chopra. Associations among BMI and patient-reported body image dissatisfaction during immediate autologous breast reconstruction: A prospective longitudinal evaluation [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-05-05.