Breast cancer and bariatric surgery: temporal relationships of diagnosis, treatment, and reconstruction

Abstract

Background: Given the increased prevalence of bariatric surgery, a certain number of women will develop breast cancer before or after bariatric intervention. Whether bariatric surgery reduces the risk of breast cancer remains uncertain. Similarly, reconstructive options for these patients and timing of reconstruction relative to their weight loss have not been established.

Methods: Patients who underwent bariatric procedures from 1992 to 2007 and were diagnosed with breast cancer from 1988 to 2007 were assessed. Outcome measures included age, body mass indices, timing of cancer diagnosis, type of bariatric procedure, treatment and reconstructive modalities, postoperative complications, and comorbidities.

Results: A total of 2878 women underwent bariatric procedures and 112,085 women had breast cancer diagnoses. Thirty-six women had breast cancer diagnosed before (group I) and 13 after bariatric surgery (group II) (p < 0.001). Group I had a mean age of 49.4 years and mean body mass index of 56.3. One woman underwent unilateral autologous/implant reconstruction followed by bariatric surgery and subsequently required revision. Three women in group II (mean age at diagnosis, 48.3 years; mean pre-weight loss body mass index, 53.5; mean body mass index at diagnosis, 32.9; mean time from bariatric surgery, 33 months; mean follow-up from reconstruction, 18 months) underwent autologous free tissue reconstruction; one required two revisions because of further weight loss.

Conclusions: Complication profiles related to reconstruction may be compounded by timing of bariatric surgery and subsequent weight loss. Further multicenter prospective analysis should aid in assessing cancer risk after weight loss along with timing of reconstruction to optimize outcomes in this population.