P2-16-04: Abdominal Wall Stability and Flap Complications Are Unaltered Following Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction Despite Increasing Body Mass Index: Analysis of 418 Patients and 639 Flaps.
Authors: Ochoa O , Chrysopoulo M , Nastala C , Ledoux P , Pisano S 
Published: June 2012

Introduction: Promoted by reports of decreased donor-site morbidity compared to traditional transverse rectus abdominus (TRAM) flap breast reconstruction, deep inferior epigastric perforator (DIEP) flaps have gained significant popularity. Increasing body mass index (BMI) is associated with poor flap-specific and donor-site outcomes in breast reconstruction using traditional techniques. The current study aims at defining flap-specific and donor-site complications with increasing BMI in patients undergoing DIEP flap breast construction. Methods: A retrospective analysis of 639 DIEP flaps on 418 consecutive patients between Jan 2006 to March 2008 was performed. Patients were stratified into five groups based on BMI: normal weight (≤ 24.9), overweight (25-29.9), obese (30-34.9), severely obese (35-39.9), and morbidly obese (≥ 40). Medical co-morbidities, adjuvant chemo-radiation therapy, timing of reconstruction, active tobacco use and surgical history were collected. Primary outcomes were compared between BMI groups.

Results: Average BMI for the entire population was 28.3 (range 17–42). There were 100 (23.9 %) normal weight, 153 (36.6 %) overweight, 113 (27.0 %) obese, 45 (10.8 %) severely obese, and 7(1.7%) morbidly obese patients with an average follow-up of 1088 (range 720–1528) days. Increasing BMI was associated with increased incidence of hypertension, previous abdominal surgeries, and length of follow-up. Age, active tobacco use, adjuvant chemo-radiation therapy and timing of reconstruction were similar across all BMI groups. Flap complications stratified by BMI groups demonstrated significantly increased delayed wound healing complications in severely obese patients compared to lower BMI groups. Incidence of flap soft tissue infections, hematoma or seroma formation, fat necrosis, thrombotic and overall complications including flap failure were not significantly different between groups. Donor-site complications stratified by BMI demonstrated significantly increased delayed wound healing and overall complications among morbidly obese patients compared to other groups. Incidence of donor-site infection, acute or subacute hematomas, seroma formation, abdominal wall bulging, and hernia formation were not significantly different between groups despite increasing BMI.

Conclusion: Increasing BMI predisposes patients to delayed wound healing complications in both flap and donor-site locations. Nevertheless, overall flap complications remain similar across all BMI groups. Despite increased overall donor-site complications in patients with increasing BMI, abdominal wall stability was maintained during a follow-up period approximating 3 years. Given a similar flap complication profile and maintenance of abdominal stability, DIEP flaps are recommended in patients with increased BMI.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-04.