Bilateral breast reconstruction with deep inferior epigastric perforator flaps in slim patients.
BACKGROUND
Slim women are not always considered candidates for bilateral autologous breast reconstruction. The study aims to assess the volume considerations and complications of deep inferior epigastric perforator (DIEP) flap in bilateral breast reconstruction among slim patients.


METHODS
All patients undergoing bilateral DIEP breast reconstruction at the Royal Marsden Hospital, London, September 2007-March 2015, were reviewed. Flap weight was compared to mastectomy weight (weight ratio) and complications were recorded. Subgroup analyses according to Body Mass Index (BMI) were performed.


RESULTS
One-hundred seventy patients (340 flaps) were included. There were 42 in the slim-group (BMI <25) (84 flaps), 70 in the traditional (BMI = 25.0-29.9) (140 flaps), and 58 in the obese (BMI >30) (116 flaps). There were no significant differences in reconstruction weight ratio between the slim and the traditional groups (1.04 ± 0.31 versus 0.95 ± 0.38, p = .267). When comparing the slim to obese group the ratio was lower for the obese group, inferring that a larger reconstruction was performed (p = .016). Complications was less frequent in the slim group compared to the traditional and the obese groups (31% compared to 50% and to 53% (p = .060 and p = .021, respectively). Donor-site specific complications did not differ between groups (29% 26% and 29%; p = .823 and .830, respectively).


CONCLUSIONS
The DIEP flaps may be a safe option for bilateral breast reconstruction among patients with BMI <25 without sacrifice in volume or increase in donor-site complications; low BMI does not in itself contraindicate bilateral DIEP breast reconstruction.
Department of Plastic and Reconstructive Surgery, The Royal Marsden Hospital, London, United Kingdom.|Department of Surgical Sciences, Section of Plastic and Reconstructive Surgery, Uppsala University, Uppsala, Sweden.
Maria
http://orcid.org/0000-0002-5387-6343
M
Mani
Department of Plastic and Reconstructive Surgery, The Royal Marsden Hospital, London, United Kingdom.
Samer
http://orcid.org/0000-0003-0867-6489
S
Saour
Department of Plastic and Reconstructive Surgery, The Royal Marsden Hospital, London, United Kingdom.
Kelvin
K
Ramsey
Department of Plastic and Reconstructive Surgery, The Royal Marsden Hospital, London, United Kingdom.
Kieran
K
Power
Department of Plastic and Reconstructive Surgery, The Royal Marsden Hospital, London, United Kingdom.
Paul
P
Harris
Department of Plastic and Reconstructive Surgery, The Royal Marsden Hospital, London, United Kingdom.
Stuart
S
James
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D019074:Epigastric Arteries / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013851:Thinness; D016896:Treatment Outcome; D006113:United Kingdom