Obese Patients Undergoing Implant-based Breast Reconstruction: A Propensity Score–Matched Analysis

Background: Breast reconstruction following oncologic mastectomy is an integral component of comprehensive breast cancer care, with implant-based reconstruction consistently being reported to be the most commonly performed worldwide. Although immediate reconstruction offers the clear benefit of reducing the number of necessary surgical procedures and providing immediate aesthetic results, concerns persist regarding its feasibility in high-risk patient populations. Obesity has been suggested to be a potential contributor to lymphatic dysfunction and impaired lymphatic vasculature; both mechanisms can predispose patients to the development of postmastectomy lymphedema. Postmastectomy lymphedema is a chronic, debilitating condition with significant implications on quality of life, functional capacity, and healthcare utilization. Established risk factors include axillary lymph node dissection, radiation therapy, and the extent of mastectomy resection. Timing of reconstruction, however, especially in obese patients undergoing implant-based reconstruction, has not been clearly delineated. Methods: Retrospective TriNetX cohort of obese adults undergoing implant-based breast reconstruction compared immediate versus delayed timing using propensity matching, assessing short- and long-term complications, including lymphedema, via risk ratios and survival analyses. Results: Among 6082 obese patients, 1944 matched pairs underwent immediate or delayed implant-based reconstruction. Immediate reconstruction showed higher 90-day complications and a persistently increased risk of lymphedema through 5 years, confirmed by Kaplan–Meier and Cox regression analyses. Conclusions: Among obese patients undergoing implant-based breast reconstruction, immediate reconstruction is associated with higher rates of early postoperative complications and a persistent increase in postmastectomy lymphedema risk compared with delayed reconstruction.