Body mass index impacts infection rates in immediate autogenous breast reconstruction

  • Lauren I. Willoughby
  • Josephine A. D’AbbondanzaEmail author
  • Healther L. Baltzer
  • James L. Mahoney
  • Melinda A. Musgrave



Risk of postoperative infection following breast cancer reconstruction warrants consideration of both classic and procedure-specific risk factors. We performed a retrospective chart review of patients with breast cancer over a 10-year period that underwent reconstructive surgery to identify factors that increase risk of postoperative infection.


Rates of postoperative infection were assessed in primary (immediate or delayed, alloplastic or autogenous) and secondary reconstructive procedures. Patient characteristics, surgical details, and cancer features were analyzed using two-sample t test and Fisher’s exact test for continuous and categorical data, respectively.


456 procedures were performed on 264 patients with 29 cases of postoperative infection (6%). Infection was more likely to occur in earlier reconstructive procedures (p < 0.03). Overall, primary reconstructive procedures were associated with a higher infection rate (p = 0.005). Other associated risk factors included: autogenous reconstruction (p < 0.018), length of admission (p < 0.001) and immediate reconstruction (p = 0.01). Subgroup analysis revealed increased risk of infection with immediate autogenous reconstruction (p < 0.03). Furthermore, patients with greater body mass index (BMI) receiving immediate autogenous reconstruction had a greater risk of infection (p < 0.003). Factors unrelated to risk of infection included history of irradiation, smoking, cancer stage, tumor type and tumor size.


Our findings suggest that risk of infection is higher in immediate autogenous reconstructions particularly when patients are overweight (BMI > 30). Our data do not support a relationship between infection and irradiation, features of cancer, or repeated reconstructive procedures. Prospective studies may be required to further validate these findings.


Breast cancer Breast reconstruction Infection Body mass index 


Compliance with ethical standards

Conflict of interest

Lauren I. Whilloughby, MD, FRCS(C), Josephine A. D’Abbondanza, MD, MSc declares , Heather L. Baltzer, MD, MSc, FRCS(C), James L. Mahoney, MD, FRCS(C), and Melinda A. Musgrave, MD, PhD, FRCS(C) declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, informed consent is not required.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Plastic Surgery, Department of SurgeryMcMaster UniversityHamiltonCanada
  2. 2.Division of Plastic and Reconstructive Surgery, Department of SurgeryUniversity of TorontoTorontoCanada

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