A Silver Lining for Massive Weight Loss Patients with Breast Cancer: A Propensity-Matched Analysis Comparing Abdominal Outcomes after DIEP and Abdominoplasty.

[OBJECTIVES] Patients with a history of massive weight loss (MWL) frequently undergo body-contouring surgery such as abdominoplasty, and the safety profile of this procedure is well accepted. The deep inferior epigastric artery perforator (DIEP) flap is a procedure where excess abdominal tissue is used to reconstruct the breast. The abdominal muscles are preserved by isolating the flap on vascular perforators to the abdominal skin and adipose tissue, whereas in abdominoplasty, the same tissue is removed and discarded. In this study, the abdominal-contouring outcomes of patients who underwent DIEP breast reconstruction following MWL were compared with the abdominal contouring outcomes of those who received abdominoplasty following MWL.

[METHODS] A propensity-matched retrospective cohort study was performed comparing MWL patients who underwent either DIEP flap breast reconstruction after breast cancer treatments with mastectomy or abdominoplasty. Patients were matched for multiple preoperative variables. Statistical analysis included an independent-samples test and the Fisher exact test for univariate analysis and multivariate analysis for predictive variables of postoperative complications.

[RESULTS] Eighteen patients with a history of MWL who underwent DIEP flaps were matched to 18 patients who underwent abdominoplasty. Patient data for the DIEP cohort were obtained from a database of 314 patients and a total of 484 flaps performed at our institution. Patient data for the abdominoplasty cohort were obtained from a database of 155 patients who underwent abdominoplasty at our institution. Groups differed on body mass index and total body weight loss ( = 0.008 and = 0.002, respectively), but they did not differ in excess body weight loss ( = 0.094). All abdominoplasty patients and 50% of the DIEP patients had undergone bariatric surgery. Complication rates at the abdominal site were similar between the two groups (DIEP 33% vs body-contouring surgery 39%, = 0.73).

[CONCLUSIONS] Patients with DIEP procedures were found to have abdominal complication rates similar to those who received standard abdominoplasty. This information can be used by plastic surgeons to counsel MWL patients considering DIEP that their chance of a postoperative abdominal complication is similar to abdominal body-contouring procedures.