title: 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.
abstract: 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. CLINICAL QUESTION/LEVEL OF EVDENCE: Risk, II.
authors: San Antonio, Texas From the Plastic Reconstructive and Microsurgical Associates of South Texas, P.A.
authors: Oscar
authors: O
authors: Ochoa
authors: Minas
authors: M
authors: Chrysopoulo
authors: Chet
authors: C
authors: Nastala
authors: Peter
authors: P
authors: Ledoux
authors: Steven
authors: S
authors: Pisano
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D019074:Epigastric Arteries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects* / Q000098:blood supply