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Is There a Benefit to Clinically Significant Weight Loss Before Undergoing DIEP Breast Reconstruction?
Varsha Harish, BS1, Christian X. Lava, MS1,2, Karen R. Li, BBA1,2, Nicole Episalla, MD2, Kelly A. Kapp, MD3, David H. Song, MD2, Kenneth L. Fan, MD2 , Rajiv P. Parikh, MD2,4
1Georgetown University School of Medicine; Washington, DC, USA. 2Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, DC, USA; 3Department of Breast Surgery, Medstar Georgetown University Hospital; Washington,DC, USA; 4 Department of Plastic and Reconstructive Surgery, MedStar Washington Hospital Center, Washington, DC, USA.

Background
Patients considering abdomen-based breast reconstruction, like DIEP reconstruction, are often advised to lower their BMI before surgery due to a higher risk of complications for those with a BMI of ≥30 kg/m2.1,2 With obesity becoming more prevalent, there exists a focus on preoperative weight loss to reduce complications.3 Studies show that major weight loss (40 to 50 kg) does not significantly increase flap failure in DIEP reconstruction.4-7 However, not all candidates can undergo bariatric surgery, but even a 3% to 5% weight reduction (CWL) could benefit them. This study aims to assess CWL's impact on postoperative outcomes in DIEP reconstruction patients.

Methods
A multicenter retrospective review of DIEP reconstruction patients from January 2017 to December 2021 was conducted. Patient characteristics, operative details, and complications were collected. BMI at initial consultation and at surgery were collected. CWL was defined as ≥4% weight reduction from baseline.7 Primary outcomes consisted of minor complications, including seroma, hematoma, delayed healing, dehiscence, and partial flap necrosis, and major complications which necessitated return to the operating room.


Results
A total of 328 patients (348 breasts) underwent DIEP flap reconstruction; of whom, 58 (17.7%) patients met criteria for CWL and 270 (82.3%) did not (NCWL). Mean BMI at baseline was 30.4±5.38 and 39.2±5.07 for CWL and NCWL groups, respectively (p=0.132). CWL patients had a lower incidence of minor complications than NCWL (mean=1.07, SD=0.22 vs. mean=1.50, SD=0.09 respectively; p=0.039). Multivariate regression analysis revealed significant associations between BMI at surgery and minor complications for the NCWL group (OR=1.11, 95% CI =[1.04, 1.18]).

Conclusion
Our study shows that a 4% reduction in body weight before surgery is linked to fewer minor complications in DIEP reconstruction patients. Even moderate weight loss pre-surgery could enhance safety. More research is needed to confirm the connection between weight loss and postoperative outcomes.
Post-operative Outcomes
 CWL (n=41)Non-CWL (n=307) 
 n%n%p-value
Seroma37.3%154.9%0.896
Hematoma512.2%258.1%0.863
Delayed Healing1024.4%5818.9%0.455
Dehiscence1024.4%5016.3%0.798
Infection24.9%144.6%0.569
Donor Site Complications1946.3%8929.0%0.888
Partial Flap Necrosis37.3%123.9%0.830
Complete Flap Necrosis12.4%41.3%0.905
Takeback24.9%175.5%0.498
Total Reconstructive Failure (30d)24.9%72.3%0.730
      
No. of Minor Complications per breast (mean, SD)1.07 (0.22) 1.5 (0.09) 0.039
No. of Major Complications per breast (mean, SD)0.04 (0.31) 0.03 (0.18) 0.651
n=# of breasts     


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