Metabolic Bridge Therapy before Microvascular Breast Reconstruction in Morbidly Obese Patients: A Proof-of-Concept Risk Analysis.

Abstract

Obese patients experience more complications after autologous breast reconstruction. This study evaluates how bariatric surgery modulates risk of complications in the setting of microvascular breast reconstruction. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program databases were queried for patients with body mass index (BMI) greater than or equal to 35 kg/m 2 undergoing bariatric surgery from 2017 to 2022. Outcomes included BMI and obesity-related comorbidities before and 1 year after bariatric surgery. Paired Breast Reconstruction Risk Assessment scores were analyzed to evaluate risk modulation before and after bariatric surgery in the setting of microvascular breast reconstruction. A total of 1026 patients were included with an average age of 47 and BMI of 44.7 kg/m 2 . Comorbidities included hypertension ( n = 601 [59%]), type 2 diabetes ( n = 291 [28%]), and cardiovascular disease ( n = 10 [1%]). One-year outcomes after bariatric surgery included an average BMI of 32.7 kg/m 2 , with remission of type 2 diabetes in 29% of patients. Paired Breast Reconstruction Risk Assessment analysis for microvascular breast reconstruction before and after bariatric surgery showed reduction in 30-day surgical complications (40.4% versus 24.8%; P < 0.0001), with an absolute risk reduction of 15%, a relative risk reduction of 36%, and a number needed to treat of 7. Each 1-kg/m 2 reduction in preoperative BMI was associated with a 3.4% reduction in surgical complications ( P < 0.0001). There is potential efficacy for metabolic bridge therapy in reducing complications for obese patients undergoing microvascular breast reconstruction. Risk, IV.