title: Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in Patients With Previous Bariatric Surgery: Is It Safe and Feasible?
abstract: BACKGROUND
  Obesity is widely recognized as a major health concern and a leading cause of preventable death. The correlation between obesity and breast cancer has been thoroughly described by several authors. Bariatric surgery is often associated with redundant abdominal tissue, often leading patients to consider body-contouring procedures. Autologous tissue breast reconstruction using the deep inferior epigastric artery perforator (DIEP) flap has advantages because it is tissue that is normally discarded during postbariatric body contouring.
  
  
  METHODS
  We conducted a retrospective chart review of 18 DIEP flaps performed by the senior author in 9 patients for breast reconstruction between February 2008 and May 2013. All patients underwent mastectomies. All patients underwent bariatric surgery preceding breast reconstruction. Breast reconstruction was performed immediately in 13 cases and delayed in 5 cases.
  
  
  RESULTS
  Mean age of the study population was 44.6 years (range, 41-57 years). The mean maximum body mass index of the patients was 44 (range, 37.6-52.1), and the mean current body mass index at the time of the reconstruction was 30.7 (range, 24.3-38.1). No intraoperative complications were reported. No fascia or muscle was taken during flap dissection. Mean operative time was 632 minutes (range, from 480 to 750 minutes). Average hospital stay was 4 days. No partial or total flap loss was reported. There were no postoperative hernias or bulges at the abdominal donor site.
  
  
  CONCLUSIONS
  This series represents the largest group of patients undergoing DIEP flap breast reconstruction after bariatric surgery. In the hands of experienced microsurgeons, breast reconstruction with the DIEP flap in postbariatric patients represents a low-risk option with high satisfaction.
authors.affiliation: From the *Houston Plastic and Craniofacial Surgery; and †Division of Plastic Surgery, Department of Surgery, The University of Texas School of Medicine at Houston, TX.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Martinez
authors.forename: Jules A
authors.initials: JA
authors.lastname: Walters
authors.forename: Erika A
authors.initials: EA
authors.lastname: Sato
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Hall
authors.forename: Sean G
authors.initials: SG
authors.lastname: Boutros
mesh_terms: D000328:Adult; D019074:Epigastric Arteries / Q000637:transplantation*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D017568:Rectus Abdominis / Q000637:transplantation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery*