How Big is Too Big

Spitz, Jared A; Bradford, Perry S; Aguilar, Frank G.; Turin, Sergey Y.; Ellis, Marco F.

doi:10.1097/sap.0000000000001284

Cited by 15 publications

(9 citation statements)

References 23 publications

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“…30 Similarly, Spitz et al found donor site complication rates to be equivalent between obesity classes II and III, with more of a difference between classes II and I. 44 Although these findings contrasted from ours, it is important to reiterate that our sample uniquely focused on DIEP flaps exclusively.…”

Section: Discussioncontrasting

confidence: 63%

“…The benefits of CTA imaging are well-documented: the knowledge of perforator course and caliber allows the surgeon to optimize flap design, mitigate dissection difficulty, and theoretically reduce operative time. 44 61 62 63 64 Routine use also ensures that all patients can be evaluated for preexisting abdominal scarring, flap thickness, and alternative options such as the superficial inferior epigastric system. There is evidence that the radiolucency of subcutaneous tissue may make cutaneous perforators easier to visualize in obese patients relative to leaner patients.…”

Section: Discussionmentioning

confidence: 99%

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Stratification of Surgical Risk in DIEP Breast Reconstruction Based on Classification of Obesity

Patterson

Palines

Bartow

et al. 2021

J Reconstr Microsurg

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Background From both a medical and surgical perspective, obese breast cancer patients are considered to possess higher risk when undergoing autologous breast reconstruction relative to nonobese patients. However, few studies have evaluated the continuum of risk across the full range of obesity. This study sought to compare surgical risk between the three World Health Organization (WHO) classes of obesity in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods A retrospective review of 219 obese patients receiving 306 individual DIEP flaps was performed. Subjects were stratified into WHO obesity classes I (body mass index [BMI]: 30–34), II (BMI: 35–39), and III (BMI: ≥ 40) and assessed for risk factors and postoperative donor and recipient site complications. Results When examined together, the rate of any complication between the three groups only trended toward significance (p = 0.07), and there were no significant differences among rates of specific individual complications. However, logistic regression analysis showed that class III obesity was an independent risk factor for both flap (odds ratio [OR]: 1.71, 95% confidence interval [CI]: 0.91–3.20, p = 0.03) and donor site (OR: 2.34, 95% CI: 1.09–5.05, p = 0.03) complications. Conclusion DIEP breast reconstruction in the obese patient is more complex for both the patient and the surgeon. Although not a contraindication to undergoing surgery, obese patients should be diligently counseled regarding potential complications and undergo preoperative optimization of health parameters. Morbidly obese (class III) patients should be approached with additional caution, and perhaps even delay major reconstruction until specific BMI goals are met.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Stratification of Surgical Risk in DIEP Breast Reconstruction Based on Classification of Obesity

Patterson

Palines

Bartow

et al. 2021

J Reconstr Microsurg

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“…The authors did find that a higher Adult Comorbidity Evaluation score was associated with worse outcomes, and obesity is factored into the calculation of the score. In contrast, obesity has been identified as a strong risk factor for complications in microvascular reconstruction of other anatomical regions, such as the breast 26,27 . Spitz et al 26 reported an increased risk of donor and recipient site complications in obese women undergoing autologous breast reconstruction in comparison to women with lower BMI, but differences within classes of obesity were less pronounced.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, obesity has been identified as a strong risk factor for complications in microvascular reconstruction of other anatomical regions, such as the breast 26,27 . Spitz et al 26 reported an increased risk of donor and recipient site complications in obese women undergoing autologous breast reconstruction in comparison to women with lower BMI, but differences within classes of obesity were less pronounced. However, in a large cohort of 1258 patients undergoing breast reconstruction, class III (morbid) obesity was found to be associated with worse outcomes, including both major and minor complications, than lower classes of obesity 27 .…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Outcomes of Proximal and Distal Anastomosis Sites of the Facial Artery in Head and Neck Reconstruction

Stoehr

Curran

Micallef

et al. 2021

Journal of Craniofacial Surgery

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Medication-related osteonecrosis of the jaw is a challenging condition of poorly understood etiology and pathogenesis, the management of which is complex. Each case should be managed on its individual context. Current literature notes a higher success rate in cases managed with aggressive surgical intervention, particularly in severe disease. This case does not refute this evidence, but does signify that conservative management may still be considered a valid treatment option, particularly in the elderly or medically compromised patient. Furthermore, the importance of multidisciplinary care is highlighted. The author notes that in this case conservative management was only initiated after a 2-stage surgical debridement and 6 months of antibiotics, in a situation where clinical improvement was apparent.

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“…In Sweden, active smoking is a contraindication for DIEP flap reconstruction since it is significantly associated with impaired wound healing, infection and postoperative complications such as flap loss, hematoma or fat necrosis [44][45][46]. Also a high BMI is a contraindication for DIEP flap reconstruction, since patients with a BMI >30 kg/m 2 are more likely to experience surgical as well as medical postoperative complications [47][48][49]. Swedish recommendations state that patients undergoing DIEP should have a BMI <30 kg/m 2 , quit smoking at least four weeks before surgery and be free of cancer relapse [2].…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Survival in breast cancer patients with a delayed DIEP flap breast reconstruction after adjustment for socioeconomic status and comorbidity

et al. 2021

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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How Big is Too Big

Abstract: We found obese women to have a higher rate of abdominal donor site complications; however, this risk seems to level off at class I or II obesity. We have modified our surgical technique of managing the abdominal donor site to optimize our outcomes in the morbidly obese patient population.

Cited by 15 publications

References 23 publications

Stratification of Surgical Risk in DIEP Breast Reconstruction Based on Classification of Obesity

Stratification of Surgical Risk in DIEP Breast Reconstruction Based on Classification of Obesity

A Comparison of Outcomes of Proximal and Distal Anastomosis Sites of the Facial Artery in Head and Neck Reconstruction

Survival in breast cancer patients with a delayed DIEP flap breast reconstruction after adjustment for socioeconomic status and comorbidity

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