Obesity Affects DIEP Flap Outcomes and Donor Site Complications

Purpose: The deep inferior epigastric perforator (DIEP) flap has revolutionized as an option for breast reconstruction after mastectomy. The DIEP flap is a surgical option for high risk patients, especially those who are obese. Unfortunately, obesity is speculated to increase surgical free flap complications. The purpose of this study is to determine if obesity, as determined by body mass index (BMI) is a predisposing factor leading to DIEP flap necrosis and/or donor site complications.

Methods/Materials: A retrospective chart review of ninety-two patients who underwent unilateral or bilateral DIEP flaps, between August 2005 and January 2010, was performed. Flap necrosis and donor site complications were evaluated and compared with BMI. Flap necrosis was divided into 4 groups; none, minimal, moderate, and complete. Donor site complications were considered as any wound breakdown, infection, or seroma requiring opening, drainage and secondary wound healing. Statistical analysis was performed comparing BMI between each group of flap necrosis and between groups with donor site complication and those without.

Results: A total of 161 flaps were performed on 92 women. There were a total of 32/161 (19.88%) flap complications and 22/92 (23.9%) donor site complications. There were 8 complete flap losses (4.9%). The mean age of all women was 52 years, and the mean BMI was 28.9. The mean BMI for complete flap losses was 32.91+/- 2.77. As the BMI increased, the degree of flap necrosis increased. There was a significant difference between the no flap loss and complete flap loss groups (28.37 ± 4.58 vs. 32.91 ± 2.77, p= 0.008) and between the minimal flap loss and complete flap loss groups (28.66 ± 4.67 vs. 32.91 ± 2.77, p= 0.026). There was a significant difference in BMI between the no donor site complication and donor site complication groups (28.34 ± 4.59 vs. 30.91 ± 4.79, p= 0.025).

Conclusion: In this study, we aimed to evaluate DIEP flap and donor site complications with respect to obesity. This study concludes a significant association between increasing BMI and complication rates. According to our results, as BMI increases, the risk of DIEP flap and donor site complications significantly increases.