Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Are Patients with Low Body Mass Index Candidates for Deep Inferior Epigastric Perforator Flaps for Unilateral Breast Reconstruction?
Pieter G. Koolen, M.D., Neel A. Kantak, M.D., Colette Martin, B.S., Adam M. Tobias, M.D., Bernard T. Lee, M.D., MBA, Samuel J. Lin, M.D..
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

PURPOSE:
Thin women have not traditionally been considered ideal candidates for autologous breast reconstruction given the lack of donor sites that can provide sufficient tissue. The purpose of this study was to examine the use of deep inferior epigastric perforator (DIEP) flap reconstruction in thin women undergoing immediate unilateral breast reconstruction.
METHODS:
A retrospective review of 1040 consecutive patients between June 2004 and July 2013 was performed. To improve clinical interpretability, patients were divided into three groups based on body mass index: "thin" (BMI ≤22.99), normal weight to overweight "traditional" candidates (>23 and ≤29.99), and "obese" (BMI >30). From a total of 428 unilateral reconstruction patients in the database, 381 met inclusion criteria.
RESULTS:
In all three groups, flap size was generally more than sufficient to match the mastectomy specimen, as flap weight:mastectomy weight ratio was greater than 1 in all groups with no significant difference between groups (1.1 in thin patients, 1.0 in traditional patients, and 1.0 in obese patients). Fat necrosis prevalence was lowest in the thin group (12.5%), compared to the traditional (15.9%, p=0.443) or obese (14.4%, p=0.698) groups. Prevalence of breast infection were lower in the thin patients (5.2%%) versus the traditional (8.7%, p=0.287) or obese (14.4%, p=0.033) groups. Abdominal wound healing complications and seroma were also lowest in thin patients.
CONCLUSION:
DIEP flap breast reconstruction may be an effective method for unilateral breast reconstruction even in thin patients, with lower incidence of complications than in heavier patients. While thin patients have less abdominal donor tissue, flap weights were sufficient compared to the mastectomy weights in unilateral breast reconstruction. As such, low BMI may not present a barrier in the reconstruction of a breast mound matching native breast size.


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