Effect of Central Obesity on the Outcomes of DIEP/SIEA Flap Breast Reconstructions Compared to BMI
Lovell, S. Said, M. Cody, D.
Presenter: Sabine Lovell, MD
Ananth Murthy, MD
Director Name: Ananth Murthy, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
PURPOSE: Studies have shown that as BMI and flap weights increase, so do the risk of post-op complications from free flaps used for breast reconstruction. We postulate that central obesity (visceral and subcutaneous adipose tissue) will be more predictive of unfavorable outcomes than BMI.
METHOD: A retrospective analysis was performed on patients who had DIEP/SIEA breast reconstruction after therapeutic mastectomy between January 2017 and March 2020. On pre-op CTA, visceral adipose tissue (VAT) was measured from the renal capsule to the psoas muscle and subcutaneous adipose tissue (SAT) from the rectus abdominis muscle to the skin.
80 patients underwent a DIEP/SIEA free flap. One patient was excluded from the study due to insufficient CT imaging. 79 patients for a total of 130 autologous free flaps were included in the final study analysis.
43 (65%) patients had complications with the majority of patients having a minor complication such as partial thickness/fat necrosis, hematoma or infection.
Major complications including DVT/PE occurred in two patients, 11 patients (9% of flaps) had vascular compromise requiring operative exploration, one patient developed partial flap loss while another had complete flap loss.
There was no significant relationship between BMI and complications. VAT/SAT ratio was found to be the best predictor of complications (p=0.005). VAT/SAT ratio >0.0633 increased the odds of a complication (RR 3.462).
CONCLUSION: Preliminary results favor central obesity over BMI as a surrogate for adverse outcomes following free flap breast reconstructions.
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