Free-flap reconstruction should be the go-to surgery for obese women undergoing breast reconstruction as new research shows that reconstructions using implants have a higher failure rate in such patients. The findings appear in the November issue of Plastic and Reconstructive Surgery.

Researchers led by Patrick B. Garvey¸MD,and colleagues of The University of Texas MD Anderson Cancer Center in Houston analyzed the outcomes of reconstruction after breast cancer surgery in 700 obese patients who had a body mass index (BMI) 30 or higher.

Of the total 990 reconstructions, 45% were done using implants. The remaining 55% were done with free flaps. About 80% of the reconstructions were immediate; implants were more frequently used than flaps for these.

The overall complication rate was somewhat lower for implant reconstructions: about 36%, compared to 42% when free flaps were used. But, severe complications leading to reconstruction failure were much more common with implants. The failure rate was nearly 16% when implants were used, compared to 1.5% with free flap reconstructions, the study showed.

Complications were similar overall for immediate versus delayed reconstructions. That said, immediate reconstruction using implants was linked to a higher failure rate in women with more severe obesity.

“We believe our data support flap reconstruction over implant reconstruction for class II and III obesity patients,” Garvey and coauthors conclude. In addition, if an implant reconstruction is chosen, delayed reconstruction appears preferable to immediate reconstruction for severely obese women, they write.