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Reply: The Impact of Autologous Breast Reconstruction on Body Mass Index Patterns in Breast Cancer Patients: A Propensity-Matched Analysis.

235e Reply: The Impact of Autologous Breast Reconstruction on Body Mass Index Patterns in Breast Cancer Patients: A Propensity-Matched Analysis Sir: We would like to thank Dr. Xin and colleagues for their correspondence and interest in our article, “The Impact of Autologous Breast Reconstruction on Body Mass Index Patterns in Breast Cancer Patients: A Propensity-Matched Analysis.”1 We agree with the authors that weight management among breast cancer patients is influenced by a combination of treatment, psychosocial, and behavioral factors. As the authors correctly state in their letter, only 16 percent of mastectomy patients in the unmatched study cohort underwent autologous breast reconstruction, reflecting an uneven distribution in the receipt of reconstructive surgery. Although propensity-score matching was used to reduce the risk of selection bias based on observable data, women who choose to undergo autologous breast reconstruction may be more body image conscious and therefore more motivated to maintain their weight. As our study did not survey patients before diagnosis or assess physical activity, it is unclear why women who undergo autologous breast reconstruction gain less weight, compared with patients who do not undergo reconstruction. Importantly, our study identifies younger age at diagnosis, leaner baseline body mass index, and chemotherapy as independent predictors of postdiagnosis weight gain across all mastectomy patients, irrespective of reconstructive surgery. These findings can be used to identify patients at higher risk of weight gain who may benefit from targeted weight management support to improve their survival rates. We encourage plastic surgeons to promote healthy lifestyle choices during and after breast cancer treatment, and refer these high-risk patients to oncology nutritional support services. DOI: 10.1097/PRS.0000000000004563