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Abdominal Wall Stability and Flap Complications after Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Does Body Mass Index Make a Difference? Analysis of 418 Patients and 639 Flaps

Ochoa, Oscar M.D.; Chrysopoulo, Minas M.D.; Nastala, Chet M.D.; Ledoux, Peter M.D.; Pisano, Steven M.D.

Plastic and Reconstructive Surgery: July 2012 - Volume 130 - Issue 1 - p 21e–33e
doi: 10.1097/PRS.0b013e3182547d09
Breast: Original Articles

Background: Promoted by reports of decreased donor-site morbidity, deep inferior epigastric perforator (DIEP) flaps have gained significant popularity. Increasing body mass index is associated with poor outcomes in breast reconstruction using traditional techniques. The authors aimed to define complications with increasing body mass index among patients undergoing DIEP flap breast reconstruction.

Methods: A retrospective analysis of 639 DIEP flaps in 418 patients was performed. Patients were stratified into five groups based on body mass index. Data regarding medical comorbidities, adjuvant therapies, timing of reconstruction, active tobacco use, and surgical history were collected. Primary outcomes were compared among groups.

Results: The average body mass index for the entire population was 28.3 (range, 17 to 42). Increasing body mass index was associated with increased incidence of hypertension, previous abdominal operations, and length of follow-up. Flap complications stratified by group demonstrated significantly increased delayed wound healing complications in severely obese patients compared with lower body mass index groups. Donor-site complications stratified by body mass index demonstrated significantly increased delayed wound healing and overall complications among morbidly obese patients compared with other groups. Incidence of abdominal wall bulging and hernia formation was not significantly different among groups.

Conclusions: Increasing body mass index predisposes patients to delayed wound healing complications in both flap and donor-site locations. Nevertheless, overall flap complications remain similar across all body mass index groups. Abdominal wall stability was maintained. Given a similar flap complication profile and maintenance of abdominal stability, DIEP flaps are recommended in patients with increased body mass index.


San Antonio, Texas

From the Plastic Reconstructive and Microsurgical Associates of South Texas, P.A.

Received for publication July 28, 2011; accepted January 11, 2012.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Oscar Ochoa, M.D.; 9635 Huebner Road, San Antonio, Texas 78240,

©2012American Society of Plastic Surgeons