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Topic: Aesthetic Surgery of the Breast

An analysis of underweight status on 30-

day outcomes after breast reconstruction

Anas Eid , Jon P. Ver Halen 1,2
1
1 Division of Plastic, Reconstructive, and Hand Surgery, Baptist Cancer Center, Germantown, TN 38139, USA.
2 Department of Surgery, Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA.

Address for correspondence: Dr. Jon P. Ver Halen, Division of Plastic, Reconstructive, and Hand Surgery, Baptist Cancer Center,
Germantown, TN 38139, USA. Email: jpverhalen@gmail.com

Dr. Jon P. Ver Halen is currently an Associate Professor with the Texas A&M School of Medicine,
Department of Surgery. He is also Associate Program Director of the Plastic Surgery Residency, and
Program Director of the Microvascular Surgery Fellowship.

ABSTRACT
Aim: To examine the impact of underweight body mass index (BMI) values on breast reconstruction
outcomes. Methods: The American College of Surgeons National Surgical Quality Improvement
Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent
breast reconstruction between 2006 and 2011. Patients were first stratified by breast reconstruction
modality into prosthetic or autologous cohorts, and second by BMI values into underweight
(BMI < 18.5), normal to overweight (reference, BMI 18.5-29.99), moderate obesity (BMI 30-34.99),
severe obesity (BMI 35-39.99), and morbid obesity cohorts. Multivariate logistic regression
models were used to determine independent predictors of complications. Results: With regard to
prosthetic breast reconstruction patients, obese patients demonstrated increased rates of surgical
complications, while underweight patients did not have any differences on multivariable analysis.
With respect to autologous reconstruction, risk-adjusted multivariate regression models showed
a dose dependent response between obesity and risk for surgical complications and reoperation,
but not for underweight patients. Conclusion: On multivariable analysis of over 4,600 patients,
there were no significant differences in the rates of adverse events between underweight patients
(BMI < 18.5) and their reference-weight counterparts, in spite of a significant increase in surgical
and medical complication rates in underweight patients on univariate analysis.

Key words:
Breast reconstruction; underweight; complications; body mass index; obesity

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How to cite this article: Eid A, Ver Halen JP. An analysis
of underweight status on 30-day outcomes after breast
DOI: reconstruction. Plast Aesthet Res 2016;3:8-14.
10.4103/2347-9264.171423
Received: 05-05-2015; Accepted: 18-06-2015

8 © 2016 Plastic and Aesthetic Research | Published by OAE Publishing Inc.