Impact of body mass index on surgical outcomes and delay adjuvant treatment in patients undergoing therapeutic mammoplasty for breast cancer.

[BACKGROUND] Therapeutic mammoplasty (TM) is an oncoplastic technique that combine wide excision of cancer with breast reduction, enabling breast conservation in patients with moderate-to-large breasts. The effect of body mass index (BMI) on TM and oncological outcomes remains controversial. This study aims to evaluate the complication rate in high BMI patients undergoing TM and to assess the impact on timing of adjuvant therapy.

[PATIENTS AND METHODS] Retrospective review of patients underwent TM between January 2014 and January 2024. Data recorded include age, weight, height, BMI, smoking, comorbidities, tumor type and size, lymph node status, neoadjuvant / adjuvant treatment and its timing. Surgery performed by one surgeon. All patients had contralateral reduction at the same session. Type of pedicle, weight of removed breast tissue, and postoperative complications were recorded. Statistical analysis was performed using the appropriate statistical test.

[RESULTS] About 73 patients were included in the analysis. Patient's mean age was 61 years (range: 58-67), Mean BMI 29.1 kg/m² (range: 20-43). The average weight of tissue removed per breast was 653 g (range: 219-948 g). Overall complications rate (32.8 %). Two patients returned to theatre for drainage of hematoma (2.7%) and the remaining minor wound complications were treated as outpatient. About 45 patients (61.6%) had BMI < 30 with 15 patients developed wound complication (33%). 28 patients (38.4%) had BMI ≥ 30 with nine patients developed wound complications (32%) = 0.99.No significant association between complication rates and all the recorded parameters. There was no significant delay in the initiation of adjuvant therapy (chemotherapy or radiotherapy) between patients who experienced complications (mean waiting time 70 Days) and those who did not (mean waiting time 77 days) = 0.78. One patient developed local recurrence and another patient developed distant metastasis after overall median follow up 53 months (IQ 30-89 months).

[CONCLUSIONS] TM is a safe technique for breast cancer surgery. According to our experience, patients with high BMI (>30 kg/m) can be managed with TM as this was not associated with increased complications or delay in adjuvant therapy.