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Obesity and the Anterior Abdominal Wall Vasculature: Does Weight Gain Influence Perforator Anatomy?
Matthew A. DelMauro, MD, Kevin Chen, MD, Mark L. Smith, MD, Armen K. Kasabian, MD, Neil Tanna, MD, MBA.
Northwell Health, Manhasset, NY, USA.

PURPOSE: Given the national trends in obesity, reconstructive surgeons are faced with an increasing number of overweight and obese women interested in post-mastectomy breast reconstruction. While the link between obesity and worse postoperative outcomes is well-established, few studies have explored the influence of weight gain on the vasculature of the anterior abdominal wall.
METHODS: A retrospective, radiographic review was conducted of all female patients who underwent computed tomographic angiography (CTA) of the anterior abdominal wall between January 2009 and December 2013. CTA studies were evaluated for perforator quality and quantity. Patients were stratified by body mass index (BMI).
RESULTS: There were a total of 916 hemiabdomens included in the study. There was a statistically significant positive correlation between BMI and size of the flap (p < 0.01). There was no statistically significant correlation between BMI and deep inferior epigastric artery (DIEA) diameter or mean diameter of major (> 1 mm) DIEA perforators. There was a statistically significant negative correlation between BMI and number of major DIEA perforators (p < 0.01).
CONCLUSION: Despite the increased demands of excess abdominal adiposity, DIEA perforator caliber was unaffected by weight gain. That the number of major DIEA perforators decreased with increasing body weight may indicate either a limitation of CTA imaging protocols in overweight and obese patients or increased importance of the superficial inferior epigastric system.


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