Impact of Obesity in Microsurgical Breast Reconstruction: Flap and Donor Site Complications

Impact of Obesity in Microsurgical Breast Reconstruction: Flap and Donor Site Complications

Background: Previous studies identified obesity as a decreasing factor of reliability when opting for flap reconstruction, either pedicled or free ^1,2,3. Deep inferior epigastric perforator flap (DIEP) has a delicate dissection and obesity may add to dissection time, operation room/ anesthesia time, hospital stay, donor site and flap complications ^2,3. 

The purpose of this study is to demonstrate that deep inferior epigastric perforator (DIEP) flap is a reliable choice of reconstruction for obese patients.

Methods:

Retrospective analysis of 77 breast reconstructions with autologous free flap performed in 62 patients per same surgeon from 2008 to 2011. Body Mass Index (BMI) varied from 20.2 to 42.1 with average of 29.1 (with standard deviation of 5.13)

Other parameters assessed were age, history of tobacco abuse, diabetes, hypertension, hyperlipidemia, thyroid dysfunction, previous abdominal surgery, immediate versus delayed reconstruction, chemotherapy, hormone therapy, and radiation before reconstruction.

Complications were defined as flap loss, partial flap necrosis, fat necrosis, arterial thrombosis, venous congestion or thrombosis, incisional hernia, wound infection.

Results: In 66 cases (85.7%), a deep inferior epigastric perforator flap (DIEP) was completed. Eleven (14.3%) flaps were converted to muscle sparing free Transverse Rectus Abdominis myocutaneous free flap (ms TRAM).

Vessel thrombosis and flap loss (6%) remained an infrequent complication even in obese patients. In our study incidence of abdominal bulging and hernia was 3.9% with no correlation with BMI. Although there was no statistical difference a progression toward increased wound infection was observed as BMI increased (table 1).

Statistically there was a similar overall complication rates distributed across all BMIs with no significant difference with interval of significance of 5% when comparing BMI and complications. (table 2)

Conclusion: Obese patients should be aware of increase risk of complications when compared with non-obese patients. DIEP flap is an autologous reconstruction, with better flap perfusion, decreased abdominal wall morbidity and limitation of donor site abdominal incision. Nonetheless, elevated body mass index should not be a contra-indication for DIEP flap.

Table 1 – BMI and Wound infection

Table 2 – BMI and Overall complications