DIEP flap for breast reconstruction: Is abdominal fat thickness associated with post-operative complications?

Ali Modarressi; Camillo Theo Müller; Xavier Montet; Eva Meia Rüegg; Brigitte Pittet-Cuénod

doi:10.1016/j.bjps.2017.05.002

DIEP flap for breast reconstruction: Is abdominal fat thickness associated with post-operative complications?

J Plast Reconstr Aesthet Surg. 2017 Aug;70(8):1068-1075. doi: 10.1016/j.bjps.2017.05.002. Epub 2017 May 18.

Authors

Ali Modarressi¹, Camillo Theo Müller², Xavier Montet³, Eva Meia Rüegg⁴, Brigitte Pittet-Cuénod⁴

Affiliations

¹ Division of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva Faculty of Medicine, Geneva, Switzerland. Electronic address: ali.modarressi@hcuge.ch.
² Division of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva Faculty of Medicine, Geneva, Switzerland; Department of Plastic Reconstructive and Hand Surgery, University Hospitals of Lausanne, University of Lausanne Faculty of Medicine, Lausanne, Switzerland.
³ Department of Radiology, Geneva University Hospitals, University of Geneva Faculty of Medicine, Geneva, Switzerland.
⁴ Division of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva Faculty of Medicine, Geneva, Switzerland.

PMID: 28602265
DOI: 10.1016/j.bjps.2017.05.002

Abstract

Introduction: Some surgeons consider a high body mass index (BMI) or important abdominal fat excess as contraindications for breast reconstruction with free deep inferior epigastric perforator (DIEP) flap. This study aimed to identify factors associated with post-operative complications by using this type of flap, with an emphasis on BMI and abdominal subcutaneous fat thickness.

Methods: A retrospective chart review of 105 consecutive patients who underwent DIEP flap breast reconstruction at our institution was performed to assess post-operative complications. Among other risk factors, we specifically studied the influence of BMI and abdominal wall thickness on complication occurrence. Abdominal wall thickness was measured at 10 different points on the angio-computed tomography scan performed pre-operatively.

Results: Median age was 49.8 years (range, 27-69); average BMI was 25.57 kg/m² (range, 18.07-41.91). Immediate breast reconstruction was performed for 35% of patients, and five patients (4.7%) underwent bilateral reconstruction. Twenty-six patients (24.8%) presented 29 post-operative complications; 12 concerned abdominal complications (delayed wound healing [n = 6] and seroma [n = 6]) and 17 were related to complications of the reconstructed breast (six minimal necrosis treated conservatively, eight minor necrosis requiring surgical debridement and three total flap loss). The complication rate was not correlated with increased BMI or abdominal wall thickness. The only factor that significantly predicts DIEP flap complications was pre-operative radiotherapy (odds ratio = 4.05; p = 0.03).

Conclusions: No significant correlation was observed between BMI of 25-35 kg/m² or abdominal wall thickness and post-operative complications of the donor site or DIEP flap. Therefore, these factors should not be considered as contraindication criteria.

Keywords: Body mass index; Breast reconstruction; Complications; DIEP; Free flap; Obesity.

MeSH terms

Adult
Aged
Body Mass Index
Breast / pathology*
Computed Tomography Angiography
Female
Humans
Mammaplasty / adverse effects*
Middle Aged
Necrosis
Perforator Flap / adverse effects*
Perforator Flap / pathology*
Postoperative Complications / etiology*
Postoperative Complications / surgery
Radiotherapy / adverse effects
Reoperation
Retrospective Studies
Risk Factors
Subcutaneous Fat, Abdominal / anatomy & histology*
Subcutaneous Fat, Abdominal / diagnostic imaging