DIEP Breast Reconstruction in the Obese Population: Assessing the Complication Risk of Your Patient

Plastic and Reconstructive Surgery, Global Open

article

Charles W. Patterson¹  Matthew Bartow¹  Mark W. Stalder¹  Hugo St. Hilaire¹ 

[1]Louisiana State University School of Medicine

DOI  :  10.1097/01.GOX.0000696004.21479.d9

学科分类：社会科学、人文和艺术（综合）

来源: Wolters Kluwer

【 摘 要 】

Background: Although obesity is known to increase operative complications, no study has stratified this risk by levelof obesity in patients seeking deep inferior epigastric perforator (DIEP) flap breast reconstruction.Methods: The authors conducted a retrospective reviewcomposed of all DIEP flap breast reconstructions performed on patients with a body mass index above 30 kg/m2at our institution between 1993 and 2014. Reconstructionswere stratified into the three classes of obesity establishedby the WHO: class I (BMI 30.0-34.9); class II (BMI 35.0-39.9); and class III (BMI 40.0+). Obesity was the primarypredictor variable. Secondary predictor variables weredemographic and comorbidity data. Primary outcomes werecomplete and partial flap loss. Secondary outcomes such ashematoma were also assessed for the flap and abdominaldonor area.Results: There were 174 flaps in class I, 69 in class II, and63 in class III. The incidence of tobacco use, diabetes, andpre-operative radiation had significant differences betweenthe groups. Univariate analysis showed no significant differences in primary or secondary outcome variables between thegroups. Logistic regression demonstrated that degree of obesity is an independent risk factor for flap (OR 1.71; p = 0.03)and abdominal donor site complications (OR 2.40; p = 0.03).Conclusions: Class III obesity patients have significantlyelevated risk when undergoing DIEP flap breast reconstructions relative to patients with class I or II obesity. It is advisable to approach these cases with additional caution andperhaps even delay major reconstruction until after specificBMI goals have been met.

【 授权许可】

CC BY-NC-ND