Methods: We retrospectively reviewed the computerized records of 52 women undergoing 60 DIEP flap reconstructions after mastectomy. Patients were divided into three groups based on body mass index: normal (BMI up to 24.9), overweight (BMI 25-29.9), and obese (BMI ≥ 30). Demographic information, preoperative comorbid conditions, and cancer information was collected and compared between the three groups. Postoperative immediate and delayed complications were compared for the flap site and the donor site.

Results: Flap complications were similar between all three groups, with only one flap failure. Fat necrosis rates were 3.6% for the normal weight patients, 5% for the overweight patients and 0% for the obese patients. Postoperative hospital time was similar for all groups. Immediate donor-site complications were more common in the overweight and obese groups. Most of these were limited to the abdominal skin incision and abdominal skin flaps. The only delayed complication of an abdominal wall hernia occurred in an overweight patient due to inadvertent division of the inguinal ligament. Large (>900 grams) reconstructions were completed without prohibitive complications in the reconstruction flap.

Conclusions: The DIEP flap represents a significant advance in autologous breast tissue reconstruction. While concerns regarding fat necrosis rates in DIEP flaps have been voiced, we did not see an increasing rate of fat necrosis or other flap complications in our obese patient population. Donor-site complications do show a proportional increase with increasing weight. Most of these are related to poor wound healing of the abdominal skin incision and abdominal skin flaps. Our data also show that the complete sparing of the rectus abdominis muscles afforded by the DIEP flap avoids abdominal wall complications often seen in obese TRAM reconstruction patients. The DIEP flap likely represents the preferred autologous breast reconstruction technique for overweight and obese patients.