Are patients with low body mass index candidates for deep inferior epigastric perforator flaps for unilateral breast reconstruction?

Abstract

Thin women have not traditionally been considered ideal candidates for autologous breast reconstruction. The purpose of this study was to examine the use of deep inferior epigastric perforator (DIEP) flap reconstruction in thin women undergoing immediate unilateral breast reconstruction. A retrospective review of 1,040 consecutive patients was performed. In total, 381 patients met the inclusion criteria. To improve clinical interpretability, patients were divided into three groups based on body mass index: "thin" (BMI ≤ 22.99), "traditional" (>23 and ≤29.99), and "obese" (BMI >30) candidates. Flap characteristics were compared to mastectomy weights, and postoperative complications were analyzed. In all groups, flap size was generally more than sufficient to match the mastectomy specimen, as flap weight:mastectomy weight ratio ws greater than 1 in all groups with no significant difference between groups (1.1 in thin patients, 1.0 in traditional patients, and 1.0 in obese patients). Fat necrosis prevalence was lowest in the thin group (12.5%), compared to the traditional (15.9%, P = 0.443) or obese (14.4%, P = 0.698) groups. Prevalence of breast infection were lower in the thin patients (5.2%) versus the traditional (8.7%, P = 0.287) or obese (14.4%, P = 0.033). Abdominal wound healing complications and seroma were also lowest in thin patients. DIEP flap breast reconstruction may be an effective method for unilateral breast reconstruction in thin patients, with sufficient flap weights and lower incidence of complications than in heavier patients. As such, low BMI may not present a barrier in the reconstruction of a breast mound matching native breast size.

Donor site morbidity following DIEP flap for breast reconstruction in Asian patients: Is it different?

“…One notable point is that our patient cohort had a low incidence of obesity, diabetes mellitus, and smoking, compared to these Western studies. Considering that these factors are well known to affect wound healing, the overall complication rate of 23.5% in our study may seem slightly higher than expected. However, we included the hypertrophic scar in the overall complication rate, which was not counted in most Western studies.…”

Smoking increases donor site complications in breast reconstruction with DIEP flap

“…Over time there have been attempts to define risk factors for postoperative complications in order to better select patients suitable for DIEP reconstruction. The impacts of smoking and body mass index (BMI, kg/ m 2 ) on complication rates in reconstructive breast surgery have been described in several studies, but conclusions are not always congruent [3][4][5][6][7][8][9][10][11]. A clear association between smoking and postoperative wound infections after abdominoplasties has been described by Araco et al [12].…”

Low‐rise scar deep inferior epigastric artery perforator flap for breast reconstruction

“…Even in patients who do not need abdominoplasty, an abdominal flap remains the ideal donor site to achieve enough volume for breast reconstruction . Our newly‐designed low‐rise scar DIEP flap was devised for patients with poor abdominal skin laxity.…”

“…When the vertical flap width is large enough, a sufficient distance between the umbilicus and donor site scar can be obtained. Patients with low body mass indexes are also candidates for DIEP flaps because of low complication incidence rates . However, when thin or nulliparous patients undergo breast reconstruction with a DIEP flap, there may be limitations for the vertical skin paddle width.…”

“…Patients with low body mass indexes are also candidates for DIEP flaps because of low complication incidence rates. 1 However, when thin or nulliparous patients undergo breast reconstruction with a DIEP flap, there may be limitations for the vertical skin paddle width. Because the skin is tight, the surplus abdominal skin width for flap elevation is small.…”