Impact of body mass index on free DIEP flap breast reconstruction: A multicenter cohort study.

Published on Aug 1, 2021in Journal of Plastic Reconstructive and Aesthetic Surgery2.39
· DOI :10.1016/J.BJPS.2020.12.043
Paul I. Heidekrueger10
Estimated H-index: 10
(University of Regensburg),
Uv Fritschen1
Estimated H-index: 1
+ 4 AuthorsLukas Prantl29
Estimated H-index: 29
(University of Regensburg)
Source
Abstract
Summary Introduction Several patient related factors have been identified with regard to the safety and efficacy of breast reconstructions. This study analyzed the largest series of microsurgical breast reconstructions in Germany using DIEP flaps, with a focus on the impact of patient BMI. Patients and Methods 3911 female patients underwent 4561 free DIEP-flap breast reconstructions across 22 different centres. The cases were divided into five groups using World Health Organization BMI criteria: underweight group (BMI Results Overall, there was no significant difference regarding the rate of partial- and total flap loss between all BMI groups (p>0.05). However, overweight and obese patients showed significantly higher rates of postoperative infections at the donor and recipient site, as compared to the control group (donor site infections: overweight 0.6%; moderately obese 0.9%; severely obese 2.4% vs. control 0.1%; all p Conclusion Our findings suggest that successful free tissue transfer can be achieved even in an underweight and severely obese population with acceptable risk for complications.
References47
Newest
#1Lukas Prantl (University of Regensburg)H-Index: 29
#2Nicholas MoellhoffH-Index: 5
Last. Paul I. HeidekruegerH-Index: 10
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INTRODUCTION Breast reconstruction with autologous tissue is a state-of-the art procedure. Several patient-related factors have been identified with regard to the safety and efficacy of these reconstructions. The presented study investigates the impact of prereconstruction radiation on outcomes of deep inferior epigastric perforator (DIEP) free-flap breast reconstructions using largest database available in Europe. MATERIALS AND METHODS Between 2011 and 2019, 3926 female patients underwent 4577 ...
5 CitationsSource
#1Paul I. Heidekrueger (University of Regensburg)H-Index: 10
#2Uwe von FritschenH-Index: 4
Last. Lukas Prantl (University of Regensburg)H-Index: 29
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Introduction: Venous anastomosis remains to be a challenging step in microsurgical tissue transfer and venous complications constitute to a common reason for free flap failure. While several studies have compared mechanical vs. hand-sewn venous anastomoses, there is no large-series study comparing the type of anastomosis exclusively in DIEP flap breast reconstructions. Patients and Methods: Between 2011 and 2019, 3926 female patients underwent 4577 free DIEP-flap breast reconstructions in 22 dif...
4 CitationsSource
#1Lukas Prantl (University of Regensburg)H-Index: 29
#2Nicholas Moellhoff (LMU: Ludwig Maximilian University of Munich)H-Index: 5
Last. Paul I. Heidekrueger (University of Regensburg)H-Index: 10
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PURPOSE Immediate breast reconstruction (IBR) at the time of mastectomy is gaining popularity, as studies show no negative impact on recurrence or patient survival, but better aesthetic outcome, less psychological distress and lower treatment costs. Using the largest database available in Europe, the presented study compared outcomes and complications of IBR vs. delayed breast reconstruction (DBR). METHODS 3926 female patients underwent 4577 free DIEP-flap breast reconstructions after malignanci...
7 CitationsSource
#1Lukas Prantl (University of Regensburg)H-Index: 29
#2Nicholas Moellhoff (LMU: Ludwig Maximilian University of Munich)H-Index: 5
Last. Paul I. Heidekrueger (University of Regensburg)H-Index: 10
view all 11 authors...
BACKGROUND Several patient-related factors have been identified with regard to the safety and efficacy of breast reconstructions. Using the largest database available in Europe, the presented study investigated the impact of cigarette smoking on deep inferior epigastric artery perforator (DIEP) free-flap breast reconstructions. METHODS In total, 3,926 female patients underwent 4,577 free DIEP-flap breast reconstructions after malignancies in 22 different German breast cancer centers. The cases w...
11 CitationsSource
BACKGROUND: The loss of a breast, and thus of the female body shape, is often extremely traumatising for women affected. Although free flap grafts have become the gold standard in reconstructive breast surgery, it has not been possible to date to unequivocally document their superiority over conventional alternative techniques. To date, there are no data on the care situation in Germany. Neither the number of reconstructions nor the proportion of the individual techniques is known. A prospective...
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BACKGROUND: Body mass index has been shown to be a predictor of outcomes after subpectoral expander/implant reconstruction, with every unit increase in body mass index increasing the risk of complications by approximately 6 percent. The effect of body mass index on complications after prepectoral reconstruction has not yet been evaluated and is the purpose of this study. METHODS: A total of 366 reconstructed breasts from 197 patients were stratified into five body mass index groups (normal; over...
9 CitationsSource
#1Oscar Ochoa (University of Texas Health Science Center at San Antonio)H-Index: 10
#2Ramon Garza (University of Texas Health Science Center at San Antonio)H-Index: 5
Last. Chet NastalaH-Index: 4
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Background Breast reconstruction plays a significant role in breast cancer treatment recovery. Introduction of the BREAST-Q questionnaire has facilitated quantifying patient-reported quality-of-life measures, promoting improved evidence-based clinical practice. Information regarding the effects of body mass index on patient-reported outcomes and health-related quality of life is significantly lacking. Methods Consecutive deep inferior epigastric perforator (DIEP) flap breast reconstruction patie...
11 CitationsSource
#1Amartya Mukhopadhyay (NUS: National University of Singapore)H-Index: 11
#2Yanika Kowitlawakul (NUS: National University of Singapore)H-Index: 13
Last. Bee Choo Tai (NUS: National University of Singapore)H-Index: 35
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Summary Background & aims Asians with similar body mass index (BMI) as the Caucasians are at higher health risk as compared to their counterparts. Although the mean weight of patients admitted to the intensive care unit (ICU) is increasing but the relation between BMI with 28-day mortality and length of stay (LOS) following ICU discharge in Asian patients is not well studied. Methods We included all adult patients admitted to the ICU of a tertiary hospital who received mechanical ventilation (MV...
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#1Tyler S. Wahl (UAB: University of Alabama at Birmingham)H-Index: 11
#2Fenil C PatelH-Index: 1
Last. Melanie S. MorrisH-Index: 20
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BACKGROUND: Obese patients undergoing colorectal surgery are at increased risk for adverse outcomes. It remains unclear whether these risks can be further defined with more discriminatory stratifications of obesity. OBJECTIVE: The purpose of this study was to understand the association between BMI and 30-day postoperative outcomes, including surgical site infection, among patients undergoing colorectal surgery. DESIGN: This was a retrospective cohort study. SETTINGS: The 2011-2013 American Colle...
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#1Adriana C. Panayi (Brigham and Women's Hospital)H-Index: 9
#2Riaz Agha (Guy's and St Thomas' NHS Foundation Trust)H-Index: 34
Last. Dennis P. Orgill (Brigham and Women's Hospital)H-Index: 75
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Background Increased rates of both breast cancer and obesity have resulted in more obese women seeking breast reconstruction. Studies demonstrate that these women are at increased risk for perioperative complications. A systematic review was conducted to assess the outcomes in obese women who underwent breast reconstruction following mastectomy. Methods Cochrane, PUBMED, and EMBASE electronic databases were screened and data were extracted from included studies. The clinical outcomes assessed we...
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Cited By4
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#1Nicholas MoellhoffH-Index: 5
#2Lukas PrantlH-Index: 29
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Abstract Objective Over the past decade numbers of bilateral mastectomy have increased steadily. As a result, bilateral breast reconstruction is gaining popularity. The presented study compares complications and outcomes of unilateral and bilateral DIEP free-flap breast reconstructions using the largest database available in Europe. Methods Female breast cancer patients (n = 3926) receiving DIEP flap breast reconstructions (n = 4577 free flaps) at 22 different centers were included in this study...
Source
#1Riccardo E. Giunta (LMU: Ludwig Maximilian University of Munich)H-Index: 15
#2Emma Hansson (University of Gothenburg)H-Index: 17
Last. Anna Elander (University of Gothenburg)H-Index: 25
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BACKGROUND The European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) previously identified the need for harmonisation of breast reconstruction standards in Europe, in order to strengthen the role of plastic surgeons. This study aims to survey the status, current trends and potential regional differences in the practice of breast reconstruction in Europe, with emphasis on equity and access. MATERIALS AND METHODS A largescale web-based qu...
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#1Paul I. Heidekrueger (University of Regensburg)H-Index: 10
#2Nicholas Moellhoff (LMU: Ludwig Maximilian University of Munich)H-Index: 5
Last. Uwe von FritschenH-Index: 4
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While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRAC), the presented study investigated the overall outcomes of deep inferior epigastric perforator (DIEP) flap reconstructions in Germany. Data of 3926 patients and 4577 DIEP flaps pe...
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