title: Outcomes of Breast Reconstruction After Mastectomy Using Deep Inferior Epigastric Perforator Flap After Massive Weight Loss.
abstract: BACKGROUND
  Because of the correlation between breast cancer and obesity, plastic surgeons may encounter patients requiring reconstructive breast surgery after massive weight loss (MWL). Use of redundant abdominal skin for deep inferior epigastric artery perforator (DIEP) flap in these patients is a novel concept whose value has not been adequately studied.
  
  
  OBJECTIVE
  Assess the outcomes of the DIEP technique for breast reconstruction in the massive weight loss population.
  
  
  METHODS
  From 103 breast reconstruction patients having 150 DIEP flap procedures, 9 DIEP flaps were performed in MWL patients. Propensity score matching was used in a 1:2 ratio. Eighteen nonweight loss (NWL) patients were selected for comparison with 9 DIEP flaps performed in 6 MWL patients.
  
  
  METHODS
  Patients in 2 groups were matched for age and body mass index (BMI). Massive weight loss patients were compared with NWL patients on the basis of immediate versus delayed reconstruction and history of radiation; DIEP flap characteristics, including coupler size, additional venous anastomosis, need for re-exploration, and flap loss; length of hospital stay; abdominal wound healing complication; and hernia or bulging.
  
  
  RESULTS
  There was no difference in the incidence of flap failures, bulging, or hernias requiring surgery in the MWL group. Additionally, there was no statistical difference in flap survival, abdominal complications, hospitalization days, operative time, or operative characteristics between the 2 groups. There was a significant positive correlation between immediate wound healing complications and comorbidities (P = 0.041). However, there was no correlation between wound healing complications and weight loss history.
  
  
  CONCLUSIONS
  Only 6 MWL patients of a single surgeon were studied.
  
  
  CONCLUSIONS
  For breast reconstruction after mastectomy, DIEP flaps can be used in MWL and NWL populations with equal flap success and abdominal donor site results. Therefore, cosmetic surgeons performing contouring procedures should consider sparing redundant abdominal tissues in patients requiring breast reconstruction.
authors.affiliation: From the *Department of Surgery, Division of Plastic Surgery, University of South Florida, Tampa, FL; †University of South Florida, Tampa, FL; ‡Moffitt Cancer Center Tampa, FL; §Department of Surgery, University of South Florida, Tampa, FL; ∥Department of Internal Medicine, USF Health Program for Comparative Effectiveness Research and Evidence Based Medicine, University of South Florida, Tampa, FL; and ¶Center for Women's Oncology Moffitt Cancer Center, Tampa, FL.
authors.forename: Deniz
authors.initials: D
authors.lastname: Dayicioglu
authors.forename: Bugra
authors.initials: B
authors.lastname: Tugertimur
authors.forename: Kyra
authors.initials: K
authors.lastname: Munzenmaier
authors.forename: Maryam
authors.initials: M
authors.lastname: Khan
authors.forename: Paul
authors.initials: P
authors.lastname: Smith
authors.forename: Michael
authors.initials: M
authors.lastname: Murr
authors.forename: Ambuj
authors.initials: A
authors.lastname: Kumar
authors.forename: Nazanin
authors.initials: N
authors.lastname: Khakpour
mesh_terms: D016022:Case-Control Studies; D019074:Epigastric Arteries / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D061525:Perforator Flap / Q000098:blood supply*; D057216:Propensity Score; D012189:Retrospective Studies; D015431:Weight Loss