Quality of life outcomes after breast reconstruction in women with a high Body Mass Index

Author: Eugene Koh

Koh, Eugene, 2020 Quality of life outcomes after breast reconstruction in women with a high Body Mass Index, Flinders University, College of Medicine and Public Health

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With the increased affluence of Western society, the prevalence of obesity in the population is climbing, with more than five million Australians, and 28.8% of Australian women, being classified as obese. This thesis presents a review of the literature on the role obesity plays in surgery, including its role in breast cancer risk, and post-operative complications. The literature review also explores the development and utilisation of the Breast-Q patient reported outcome measure, as well as its role and applications in the literature.

Obese patients have been shown to have a higher rate of post-operative complications. In Chapter 2, a case of an obese patient with a breast implant presenting with a late onset seroma is presented. Although the cause for the seroma was eventually found to be caused by an implant rupture, careful evaluation of patients presenting with a late onset seroma due to the growing concern for Breast Implant Associated Anaplastic Large Cell Lymphoma.

An obese woman seeking breast reconstruction can be limited in the options available for breast reconstruction. In Chapter 3, an alternative method for breast reconstruction, the Reverse Abdominoplasty is explored, with a case series of three patients undergoing the procedure. The procedure was found to be safe and satisfactory, and can be a viable option for breast reconstruction.

The diagnosis of breast cancer can have a tremendous psychological impact on a woman. In Chapter 4, a qualitative study was performed with an aim to explore the experiences and perspectives of obese women in relation to their cancer diagnosis, breast reconstruction journey, and perspectives into obesity.

Some common themes that emerged included difficulties coping with external i

breast prostheses, physical effects of breast cancer treatment, and the overwhelmingly positive experiences with breast reconstruction.

A study establishing the quality of life of obese women before and after breast reconstruction is detailed in Chapter 5. This is compared with the quality of life of non-obese women, as well as the relationship, to complications in the post- operative period. The study showed that obese women get the same, if not greater quality of life benefit when compared with non-obese women, despite a higher rate of minor complications.

A common theme expressed by women in Chapter 4 was the difficulty coping with external breast prostheses after mastectomy. Chapter 6 looks at the effect of the weight of the breast resected at mastectomy on the quality of life after breast reconstruction. It was found that women with a larger breast weight at mastectomy had a lower pre-operative quality of life, as well as a lower post- operative sexual well-being.

Chapter 7 was designed to study the effect of breast reconstruction using the latissimus dorsi (LD) flap on patient reported shoulder function, as well as quality of life, compared with a control group of women undergoing total mastectomy without breast reconstruction. It was found that women undergoing LD flap reconstruction had a higher quality of life outcome compared with women undergoing mastectomy without reconstruction, and there was no difference in patient reported shoulder function.

Keywords: Breast Reconstruction, Breast, Plastic Surgery, Obesity

Subject: Surgery thesis

Thesis type: Doctor of Philosophy
Completed: 2020
School: College of Medicine and Public Health
Supervisor: Dr Nicola Dean