A retrospective investigation of abdominal visceral fat, body mass index (BMI), and active smoking as risk factors for donor site wound healing complications after free DIEP flap breast reconstructions

Timmermans, Floyd W.; Westland, Pèdrou B.; Hummelink, Stefan; Schreurs, Joep; Hameeteman, Marijn; Ulrich, Dietmar; Slater, Nicholas J.

doi:10.1016/j.bjps.2018.03.003

Cited by 24 publications

(26 citation statements)

References 18 publications

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“…A comparison of subgroups differentiated according to their respective BMI category showed that being overweight (BMI 25 to ≤ 30 kg/m 2 ) or obese (BMI 30 to ≥ 40 kg/m 2 ) was associated with a higher incidence of flap-specific complications, particularly flap edge and fat necrosis (p < 0.05). Other studies have reported similar results [36,41,42].…”

Section: Discussionsupporting

confidence: 71%

The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience

Munder¹,

Andree²,

Witzel³

et al. 2020

Geburtshilfe Frauenheilkd

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Background Breast cancer is the most common cancer affecting women in Germany. Despite breast-conserving therapy (BCT) being carried out in almost 70% of cases, a high number of women still require complete mastectomy. Prophylactic mastectomy is also indicated for women with a BRCA 1/2 gene mutation. In addition to implant-based heterologous breast reconstruction, autologous breast reconstruction using a DIEP flap has been found to be beneficial, particularly for patients who had prior radiotherapy. This study aims to show that DIEP flap reconstruction surgery is the method of choice for autologous breast reconstruction with a low rate of complications. Patients and Methods Autologous breast reconstruction using a DIEP flap was performed in 1124 patients between July 2004 and December 2014. Retrospective study criteria included potential risk factors such as age, BMI, smoking, chemotherapy and/or radiotherapy, and comorbidities as well as outcome parameters such as postoperative complications. Outcomes were evaluated with a mean follow-up of 24 months. Results A total of 1124 patients underwent 1274 free DIEP flap breast reconstructions, of which 150 were bilateral reconstructions. The primary indication was previous mastectomy in 785 cases, followed by prior implant-based reconstruction in 265 cases. The total flap loss rate was 0.6%. Postoperative surgical revision for abdominal wall hernia was required in 0.2% of cases. The group with a higher BMI and the group of smokers had significantly higher complication rates. Elderly patients (> 65 years), patients who had undergone chemo-/radiotherapy and patients with diabetes did not have higher complication rates. Conclusion DIEP flap surgery is an excellent option for autologous breast reconstruction, with a low rate of donor site morbidity and low complication rates. DIEP flap surgery carried out in a specialised interdisciplinary breast centre in a standardised clinical setting after prior careful patient selection to take account of risk factors such as high BMI and smoking is a reliable method with a low complication rate and satisfactory long-term reconstruction results.

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Section: Discussionsupporting

confidence: 71%

The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience

Munder¹,

Andree²,

Witzel³

et al. 2020

Geburtshilfe Frauenheilkd

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“…20 The prevalence of these and other largescale studies has led to the widespread acknowledgment of a signification association between increasing obesity and surgical complications among patients undergoing breast reconstruction. 10,11,[19][20][21][22][23][24][25][26][27][28] Although several studies have investigated this association specifically in regard to the abdominal donor site, most series commonly include multiple abdominal flap techniques into their cohorts to increase the sample size for statistical analyses. 5,10,20,24,25,27-30 However, this makes it difficult to delineate specific conclusions about individual surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

“…20 The prevalence of these and other large-scale studies has led to the widespread acknowledgment of a signification association between increasing obesity and surgical complications among patients undergoing breast reconstruction. 10 11 19 20 21 22 23 24 25 26 27 28…”

Section: Discussionmentioning

confidence: 99%

“…Although several studies have investigated this association specifically in regard to the abdominal donor site, most series commonly include multiple abdominal flap techniques into their cohorts to increase the sample size for statistical analyses. 5 10 20 24 25 27 28 29 30 However, this makes it difficult to delineate specific conclusions about individual surgical techniques. Only a few recent studies of obese patients have focused on true DIEP flaps exclusively, 31 with only two 22 26 stratifying their cohort between WHO classes of obesity as in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Increased dead space adjacent to poorly perfused adipose, increased intraabdominal pressure, and nutritional deficiencies have also been proposed to increase risks of seroma, 39 abdominal hernia, 40 and poor wound healing 41 respectively. While increasing BMI certainly elevates these effects to some degree, 25 the successive impact of these effects at increasingly higher levels remains unclear.…”

Section: Discussionmentioning

confidence: 99%

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Stratification of Surgical Risk in DIEP Breast Reconstruction Based on Classification of Obesity

Patterson

Palines

Bartow

et al. 2021

J Reconstr Microsurg

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Background From both a medical and surgical perspective, obese breast cancer patients are considered to possess higher risk when undergoing autologous breast reconstruction relative to nonobese patients. However, few studies have evaluated the continuum of risk across the full range of obesity. This study sought to compare surgical risk between the three World Health Organization (WHO) classes of obesity in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods A retrospective review of 219 obese patients receiving 306 individual DIEP flaps was performed. Subjects were stratified into WHO obesity classes I (body mass index [BMI]: 30–34), II (BMI: 35–39), and III (BMI: ≥ 40) and assessed for risk factors and postoperative donor and recipient site complications. Results When examined together, the rate of any complication between the three groups only trended toward significance (p = 0.07), and there were no significant differences among rates of specific individual complications. However, logistic regression analysis showed that class III obesity was an independent risk factor for both flap (odds ratio [OR]: 1.71, 95% confidence interval [CI]: 0.91–3.20, p = 0.03) and donor site (OR: 2.34, 95% CI: 1.09–5.05, p = 0.03) complications. Conclusion DIEP breast reconstruction in the obese patient is more complex for both the patient and the surgeon. Although not a contraindication to undergoing surgery, obese patients should be diligently counseled regarding potential complications and undergo preoperative optimization of health parameters. Morbidly obese (class III) patients should be approached with additional caution, and perhaps even delay major reconstruction until specific BMI goals are met.

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Body mass index and abdominal wall thickness correlate with perforator caliber in free abdominal tissue transfer for breast reconstruction

Sacher

Kapalschinski

Wallner

et al. 2020

Journal of Plastic, Reconstructive & Aesthetic Surgery

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A retrospective investigation of abdominal visceral fat, body mass index (BMI), and active smoking as risk factors for donor site wound healing complications after free DIEP flap breast reconstructions

Cited by 24 publications

References 18 publications

The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience

The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience

Stratification of Surgical Risk in DIEP Breast Reconstruction Based on Classification of Obesity

Body mass index and abdominal wall thickness correlate with perforator caliber in free abdominal tissue transfer for breast reconstruction

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