The Effect of BMI on Breast and Body Contouring Outcomes

Goals/Purpose: The prevalence of obesity (BMI ≥30 kg/m²) in the United States has risen to approximately 40% among adults. More patients than ever are seeking surgical means to address excess adiposity and skin laxity. Obesity is a known risk factor for surgical complications, causing many plastic surgeons to hesitate when considering surgery in this patient population. This study seeks to evaluate the relationship between BMI and surgical outcomes with respect to breast and body contouring procedures.

Methods/Technique: This is a single surgeon retrospective review of breast and body contouring procedures from 2018-2024. Patients with follow-up less than 3 months were excluded. Patient demographics, BMI, and surgical outcomes were reviewed. Surgical complications were subcategorized into minor (wound breakdown, small dehiscence, delayed wound healing), and major (hematoma, seroma, infection, hospital transfer, surgical intervention). Statistical analysis was performed to assess the relationship between BMI and surgical complications.

Results/Complications: A total of 335 patients were included in this study. Of these, 209 patients underwent breast surgery with an average age of 42 and average BMI of 25.0. The most common breast procedures were breast reduction and mastopexy. Breast patients had a minor complication rate of 32.4% and major complication rate of 6.9%. BMI for breast patients was significantly associated with minor complications (p<0.01), but not major complications (p=0.367). With respect to minor complications on breast patient BMI subgroup analysis, there was no significant difference in comparing normal vs. overweight (p=0.255), obese class I vs. II (p=1.0), or obese class II vs. III (p=0.305). There was a significant difference in incidence of minor complications between obese and non-obese breast patients (p<0.01). BMI did not contribute to incidence of major complications in breast patients. 126 patients underwent body contouring surgery with an average age of 49 and average BMI of 28.2. The most common body contouring procedures were panniculectomy and abdominoplasty. Body contouring patients had a minor complication rate of 12.7% and major complication rate of 14.3%. BMI was not significantly associated with minor (p=0.189) or major complications (p=0.178) for body contouring patients, nor did BMI subgroup analysis yield significant differences for any surgical complications.

Conclusion: Obesity may be a risk factor for minor wound healing issues among breast surgery patients. However, it is not associated with major surgical complications in breast surgery patients, nor with either minor or major surgical complications in body contouring patients. While BMI should always be an important consideration in assessing operative candidacy, higher BMI may not negatively impact breast and body contouring surgical outcomes. With appropriate counseling and disclosure of risks, plastic surgeons may be able to offer these procedures to otherwise-healthy higher BMI individuals with confidence.