Skip to main content
SpringerLink
Log in

Abdominal Wall Stability and Flap Complications After Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Does Body Mass Index Make a Difference?

  • Chapter
Breast Reconstruction

Abstract

Promoted by reports of decreased donor-site morbidity compared to transverse rectus abdominis (TRAM) breast reconstruction, deep inferior epigastric perforator (DIEP) flaps have gained significant popularity. Increasing body mass index (BMI) is associated with poor outcomes in breast reconstruction using traditional techniques. The authors retrospectively reviewed their clinical experience based on patient BMI. Significantly increased flap delayed wound healing complications were reported in severely obese patients compared to lower BMI groups. Donor-site complications demonstrated significantly increased delayed wound healing and overall complications among morbidly obese patients compared to other groups. Incidence of abdominal wall bulging and hernia formation was not significantly different between groups despite increasing BMI.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 259.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hartrampf CR, Scheflan M, Black PW (1982) Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 69(2):216–225

    Article  PubMed  CAS  Google Scholar 

  2. Scheflan M, Kalisman M (1984) Complications of breast reconstruction. Clin Plast Surg 11(2):343–350

    PubMed  CAS  Google Scholar 

  3. Hartrampf CR, Bennett GK (1987) Autogenous tissue reconstruction in the mastectomy patient: a critical review of 300 patients. Ann Surg 205(5):508–519

    Article  PubMed  PubMed Central  Google Scholar 

  4. Scheflan M, Dinner MI (1983) The transverse abdominal island flap: Part I. Indications, contraindications, results, and complications. Ann Plast Surg 10(1):24–35

    Article  PubMed  CAS  Google Scholar 

  5. Schusterman MA, Kroll SS, Weldon ME (1992) Immediate breast reconstruction: why the free TRAM over the conventional TRAM flap? Plast Reconstr Surg 90(2):255–261

    Article  PubMed  CAS  Google Scholar 

  6. Nahabedian MY, Dooley W, Singh N, Manson PN (2002) Contour abnormalities of the abdomen after breast reconstruction with abdominal flaps: the role of muscle preservation. Plast Reconstr Surg 109(1):91–101

    Article  PubMed  Google Scholar 

  7. Alderman AK, Wilkins EG, Kim HM, Lowery JC (2002) Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 109(7):2265–2274

    Article  PubMed  Google Scholar 

  8. Kroll SS, Sharma S, Koutz C, Langstein HN, Evans GRD, Robb GL, Chang DW, Reece GP (2001) Postoperative morphine requirements of free TRAM and DIEP flaps. Plast Reconstr Surg 107(2):338–341

    Article  PubMed  CAS  Google Scholar 

  9. Selber JC, Nelson J, Fosnot J, Goldstein J, Bergey M, Sonnad SS, Serletti JM (2010) A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: Part I. Unilateral reconstruction. Plast Reconstr Surg 126(4):1142–1153

    Article  PubMed  CAS  Google Scholar 

  10. Selber JC, Fosnot J, Nelson J, Goldstein J, Bergey M, Sonnad S, Serletti JM (2010) A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: Part II. Bilateral reconstruction. Plast Reconstr Surg 126(5):1438–1453

    Article  PubMed  CAS  Google Scholar 

  11. Blondeel N, Vanderstaeten GG, Monstrey SJ, Van Landuyt K, Tonnard P, Lysens R, Boeckx WD, Matton G (1997) The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg 50(5):322–330

    Article  PubMed  CAS  Google Scholar 

  12. Nahabedian MY, Tsangaris T, Momen B (2005) Breast reconstruction with the DIEP flap or the muscle-sparing (MS-2) free TRAM flap: is there a difference? Plast Reconstr Surg 115(2):436–444

    Article  PubMed  Google Scholar 

  13. Garvey PB, Buchel EW, Pockaj BA, Casey WJ 3rd, Gray RJ, Hernández JL, Samson TD (2006) DIEP and pedicled TRAM flaps: a comparison of outcomes. Plast Reconstr Surg 117(6):1711–1719

    Article  PubMed  CAS  Google Scholar 

  14. Vyas RM, Dickinson BP, Fastekjian JH, Watson JP, Dalio AL, Crisera CA (2008) Risk factors for abdominal donor-site morbidity in free flap breast reconstruction. Plast Reconstr Surg 121(5):1519–1526

    Article  PubMed  CAS  Google Scholar 

  15. Kroll SS (2000) Fat necrosis in free transverse rectus abdominis myocutaneous and deep epigastric perforator flaps. Plast Reconstr Surg 106(3):576–583

    Article  PubMed  CAS  Google Scholar 

  16. Gill PS, Hunt JP, Guerra AM, Dellacroce FJ, Sullivan SK, Boraski J, Metzinger SE, Dupin CL, Allen RJ (2004) A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg 113(4):1153–1160

    Article  PubMed  Google Scholar 

  17. Drazan L, Vesely J, Hyza P, Castagnetti F, Stupka I, Justan I, Novak P, Monni N (2008) Bilateral breast reconstruction with DIEP flaps: 4 years’ experience. J Plast Recon Aesthet Surg 61(11):1309–1315

    Article  Google Scholar 

  18. Selber JC, Serletti JM (2010) The deep inferior epigastric perforator flap: myth and reality. Plast Reconstr Surg 125(1):50–58

    Article  PubMed  CAS  Google Scholar 

  19. Mulvey CL, Cooney CM, Daily FF, Colantuoni E, Ogbuago OU, Cooney DS, Rad AN, Manahan MA, Rosson GD, Sacks JM (2013) Increased flap weight and decreased perforator number predict fat necrosis in DIEP breast reconstruction. Plast Reconstr Surg 131(5S):83

    Article  Google Scholar 

  20. Spear SL, Ducic I, Cuoco F, Taylor N (2007) Effect of obesity on flap and donor-site complications in pedicled TRAM flap breast reconstruction. Plast Reconstr Surg 119(3):788–795

    Article  PubMed  CAS  Google Scholar 

  21. Chang DW, Wang B, Robb GL, Reece GP, Miller MJ, Evans GR, Langstein HN, Kroll SS (2000) Effects of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg 105(5):1640–1648

    Article  PubMed  CAS  Google Scholar 

  22. Seidenstuecker K, Munder B, Mahajan AL, Richrath P, Behrendt P, Andree C (2011) Morbidity of microsurgical breast reconstruction in patients with comorbid conditions. Plast Reconstr Surg 127(3):1086–1092

    Article  PubMed  CAS  Google Scholar 

  23. Garvey PB, Buchel EW, Pockaj BA, Gray RJ, Samson TD (2005) The deep inferior epigastric perforator flap for breast reconstruction in overweight and obese patients. Plast Reconstr Surg 115(2):447–457

    Article  PubMed  Google Scholar 

  24. Ueno CM, Chen E, Cohen A, Cacioppo JR (2013) Impact of obesity in microsurgical breast reconstruction: flap and donor site complications. Plast Reconstr Surg 132(4S-1):23

    Article  Google Scholar 

  25. Fischer JP, Nelson JA, Sieber B, Cleveland E, Kovach SJ, Wu LC, Serletti JM, Kanchwala S (2012) Evidence-based approach to free tissue transfer in the obese patient: analysis of 1,258 abdominally-based reconstructions. Plast Reconstr Surg 130(5S-1):78

    Article  Google Scholar 

  26. Jandali S, Nelson JA, Sonnad SS, Low DW, Kovach SJ, Wu LC, Serletti JM (2011) Breast reconstruction with free tissue transfer from the abdomen in the morbidly obese. Plast Reconstr Surg 127(6):2206–2213

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Advanced Breast Reconstruction, Plastic Reconstructive and Microsurgical Associates (PRMA) of South Texas, 9635 Huebner Road, San Antonio, TX, 78240, USA

    Oscar Ochoa M.D., Steven Pisano M.D., Minas Chrysopoulo M.D., Peter Ledoux M.D., Gary Arishita M.D. & Chet Nastala M.D.

Authors
  1. Oscar Ochoa M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven Pisano M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Minas Chrysopoulo M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Ledoux M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gary Arishita M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chet Nastala M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oscar Ochoa M.D. .

Editor information

Editors and Affiliations

  1. Tustin, California, USA

    Melvin A. Shiffman

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Ochoa, O., Pisano, S., Chrysopoulo, M., Ledoux, P., Arishita, G., Nastala, C. (2016). Abdominal Wall Stability and Flap Complications After Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Does Body Mass Index Make a Difference?. In: Shiffman, M. (eds) Breast Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-18726-6_138

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-18726-6_138

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18725-9

  • Online ISBN: 978-3-319-18726-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation