title: Complications of latissimus dorsi flap breast reconstruction in overweight and obese patients.
abstract: The latissimus dorsi flap (LDF) remains a widely used technique for postmastectomy autologous tissue breast reconstruction. The purpose of this study was to evaluate the effect of body mass index (BMI) on flap and donor-site complications in patients undergoing LDF reconstruction.
  
  
  METHODS
  All patients at Emory University Hospital between 2005 and 2010 who underwent an LDF for breast reconstruction were included. Demographics were queried, and patients were stratified into 3 groups according to BMI: normal weight (NL; BMI, <25 kg/m), overweight (OW; BMI, 25-29.9 kg/m), and obese (OB; BMI, ≥30 kg/m). Flap and donor-site complications were compared among the groups.
  
  
  RESULTS
  There were 277 patients included in the review: NL (n = 102), OW (n = 72), and OB (n = 103). Overall postoperative complication rates for flaps and donor sites were 33.5% and 22.3%, respectively. The incidence of donor-site complications was similar among BMI groups (22.5% vs 19.4% vs 24.2% for NL, OW, and OB groups, respectively). Flap-related complications occurred in 28.4% (NL), 33.3% (OW), and 38.8% (OB). When stratified by type of complication, no statistically significant difference was found in the incidence of seromas and tissue necrosis at the LDF site. Obese patients were more likely to develop mastectomy skin flaps necrosis (21.3%) compared to the NL group (9.8%, P = 0.042) and less likely to have capsular contracture and hematomas (P = 0.009 and 0.023, respectively). No difference was observed in the incidence of seroma, hematomas, infection, and skin necrosis of the donor site among BMI groups. Patients reconstructed with an LDF and tissue expander tended to have more flap-related complications compared to LDF alone (36.1% vs 25.3%, P = 0.11).
  
  
  CONCLUSIONS
  The incidence of both flap and donor-site complications after LDF was not significantly different in overweight and obese patients compared to the normal weight population. The use of LDFs in overweight and obese patients results in an acceptable incidence of postoperative complications and can be safely used in this category of patients.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Emory University Hospital, Atlanta, GA 30308, USA.myezhel@emory.edu
authors.forename: Max
authors.initials: M
authors.lastname: Yezhelyev
authors.forename: Claire S
authors.initials: CS
authors.lastname: Duggal
authors.forename: Grant W
authors.initials: GW
authors.lastname: Carlson
authors.forename: Albert
authors.initials: A
authors.lastname: Losken
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D016896:Treatment Outcome