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The Impact Of Obesity On Breast Reconstruction With Deep Inferior Epigastric Perforator Flaps
Ashlie A. Elver, MD, Matthew C. Sink, BS, Anna G. Boydstun, BS, Benjamin McIntyre, MD.
The University of Mississippi Medical Center, Jackson, MS, USA.
PURPOSE: With a prevalence of over 40% in the United States, obesity is one of the most common patient factors surgeons encounter. This study aims to characterize the effects of obesity on patient outcomes following deep inferior epigastric perforator (DIEP) flap breast reconstruction.
METHODS: A retrospective review identified all patients undergoing DIEP flaps at a single institution from 2016-2023. Patient demographics, operative characteristics, and complications were collected. Patients were separated into two cohorts for analysis such that patients with a BMI above 30 kg/m2 were classified as obese. Rates of complications between the two cohorts were compared.
RESULTS: There were 121 patients identified through this review. The average BMI was 33.5 kg/m2 with a maximum of 54.7 kg/m2. There were 81 patients in the obese cohort and 40 patients in the normal weigh cohort. There was an average of 1.55 complications in the normal weight cohort and 2.36 in the obese cohort (p=0.02). Ten patients had a BMI ≥ 40.0 kg/m2 and suffered an average of 3.10 complications (p=0.019). While breast hematoma was more common in obese patients (8.5%; p=0.04) the remaining complications were not significantly higher.
CONCLUSION: While patients with obesity may be at greater risk of experiencing complications such as breast hematoma, patients may find this an acceptable risk profile, and thus should be counseled on their candidacy to pursue autologous reconstruction. The authors advocate for continued research into specific factors affecting patient outcomes after these procedures to support equitable care for individuals with obesity.
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