Abstract PO5-11-03: Associations among BMI and patient-reported body image dissatisfaction after breast reconstruction
Authors: Bouhali Sara , Noufail Nassima , Chen Tzuan , Bordes Mary Catherine , Reece Greg , Markey Mia , Merchant Fatima , Chopra Deepti 
Published: May 2024

Abstract
INTRODUCTION
Breast reconstruction surgery helps women restore their physical appearance and contributes to overall well-being. We assessed body image concerns in the context of breast reconstruction using patient-reported outcome measures: Body Image Scale (BIS), Brief Symptom Inventory (BSI), Appearance Schemas Inventory (ASI-R), and BREAST-Q. Since obesity is known to be associated with body image dissatisfaction1, body size may influence a patient’s adjustment to bodily changes arising from breast cancer and its treatment. Thus, we investigated the associations among BMI and patient-reported body image dissatisfaction after immediate autologous breast reconstruction.
MATERIAL AND METHODS
Patients undergoing breast reconstruction surgery were enrolled in an IRB approved study from 2011 to 2014 at The University of Texas MD Anderson Cancer Center. Participants (N=44) included patients who underwent immediate autologous (DIEP/TRAM) reconstruction and completed the BIS, BSI, ASI-R, and BREAST-Q, both preoperatively and postoperatively at 12+ months. Descriptive statistics including means, standard deviations, and medians were used to summarize continuous variables, while frequencies and percentages were used to summarize the categorical clinical and demographic characteristics. Univariate analyses were conducted to identify potential factors among preoperative variables for subsequent multivariable regression analysis: age, race, ethnicity, BMI, laterality, BIS, BSI, ASI-R, BREAST-Q psychosocial wellbeing score (PWBS), and BREAST-Q satisfaction with breast score (SWBS). Factors with a t test p-value≤0.2 were considered potential predictive variables for the postoperative dependent variables BIS, BREAST-Q PWBS, and BREAST-Q SWBS. Multivariable linear regression models were used to assess the relationship between the dependent and the selected predictive variables. A multivariable linear regression model was fitted using stepwise selection procedure, and the model with the highest adjusted R-squared value and the lowest Akaike information criterion (AIC) was chosen. All tests were two-sided with p-value&lt; 0.05 considered statistically significant, and for each significant predictor, we report the unstandardized coefficient β. Analyses were performed using SPSS 29.0.0 and SAS 9.4.
RESULTS
Results from the selected models are summarized in Table 1. Age and BMI were significant predictors for postoperative BIS score. Older patients and those with BMI categorized as overweight and obese tend to feel less dissatisfied with their body image after immediate autologous breast reconstruction compared to patients with healthy BMI. Preoperative BSI anxiety was identified as significant predictor for postoperative BREAST-Q PWBS, i.e., patients with higher preoperative anxiety scores tend to have lower postoperative BREAST-Q PWBS. Preoperative BSI anxiety and laterality were significant predictors for postoperative BREAST-Q SWBS. Patients with higher preoperative anxiety scores tend to be less satisfied with their breasts after immediate autologous reconstruction and patients who underwent unilateral reconstruction tend to be less satisfied with their breasts postoperatively compared to patients with bilateral reconstruction.
CONCLUSION
Women with higher BMI may experience improved body image after undergoing immediate autologous breast reconstruction, as compared to women with healthy BMI. The use of BIS may provide more insight to plastic surgeons compared to relying solely on the body image correlates provided by the BREAST-Q. Moreover, body image counseling can be beneficial for individuals across all BMI categories, including those with healthy BMI.
REFERENCES
1. Weinberger, N.A., et al., Body Dissatisfaction in Individuals with Obesity Compared to Normal-Weight Individuals: A Systematic Review and Meta-Analysis. Obes Facts, 2016. 9(6): p. 424-441.
Table 1: Table for reporting selected multivariable linear regression models; (a) Postoperative BIS with explanatory variables age and BMI category, (b) Postoperative BREAST-Q PWBS with explanatory variable Preoperative BSI anxiety score, (c) Postoperative BREAST-Q SWBS with explanatory variables Preoperative BSI anxiety score and laterality.
Citation Format: Sara Bouhali, Nassima Noufail, Tzuan Chen, Mary Catherine Bordes, Greg Reece, Mia Markey, Fatima Merchant, Deepti Chopra. Associations among BMI and patient-reported body image dissatisfaction after breast reconstruction [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-03.