The Weight of Obesity on Timely Breast Reconstruction Surgery

Abstract

Background: Delayed care carries both clinical and psychosocial consequences for patients undergoing breast reconstruction. This study evaluated whether elevated BMI is associated with delays in post-mastectomy reconstructive care, with the aim of identifying potential contributors to outcome disparities among higher-weight patients. Methods: A single institution, retrospective review of breast reconstruction patients between 2017 and 2023 was conducted. Patients were stratified by World Health Organization BMI classifications. Outcomes comprised intervals between diagnosis and plastic and reconstructive surgery (PRS) consultation, index procedure, and final procedure. Regression models evaluated associations between BMI and clinical timelines. Results: Of the 1659 patients included, 26 were underweight (1.6%), 599 were healthy weight (36.1%), 520 were overweight (31.3%), 322 were Class I obese (19.4%), 144 were Class II obese (8.7%), and 48 were Class III obese (2.9%). On univariable analysis, prolonged intervals between diagnosis to index procedure were observed for Class I (β = 0.187, P = 0.01) and Class II (β = 0.276, P = 0.004) obesity patients; however, these findings did not persist after adjusting for demographics, operative details, and comorbidities. Intervals between diagnosis and PRS consult did not show significant differences among BMI classes. Conclusion: While extended intervals to the index reconstructive procedure among obese patients suggest care delays occur after PRS consultation, the absence of significant associations in multivariable analysis indicates that comorbidities and sociodemographic factors are the primary contributors. These findings offer reassurance that elevated BMI does not independently impede timely receipt of breast reconstruction.