Microsurgical Breast Reconstruction in Thin Patients: The Impact of Low Body Mass Indices

Abstract

Patients undergoing autologous breast reconstruction have been shown to have higher overall rates of long-term satisfaction when compared with patients with implant-based reconstructions.1-5 While there is a national trend toward increasing rates of implant-based breast reconstructions, certain centers show microsurgical breast reconstruction is being increasingly performed for both therapeutic and prophylactic indications. [6][7][8][9][10] This rise in the use of autologous tissue for breast reconstruction is likely because of both an expanding spectrum of patients who are being offered free tissue transfer as well as an overall rising incidence breast reconstruction. Keywords► low BMI ► breast reconstruction ► thin AbstractBackground The purpose of this investigation was to examine patients with low body mass index (BMI) regarding the feasibility to perform autologous breast reconstruction in such patients, as well as to determine optimal donor sites and evaluate outcomes accordingly.Patients and Methods All patients undergoing microsurgical breast reconstruction were divided into three cohorts based on BMI. Group 1 included patients with BMI greater than or equal to 22 kg/m 2 and was defined "low-normal BMI." Patients with BMI

The transverse musculocutaneous gracilis flap for autologous breast reconstruction: focus on donor site morbidity

“…Autologous breast reconstruction in thin patients is often challenging due to an apparent lack of adequate donor sites. Previous studies indicated TMG flap breast reconstruction to be more likely performed in slim and normal weight patients compared with those having abdominal-based breast reconstruction [ 6 , 13 , 18 , 19 ].…”

“…However, an adequate TMG flap volume with a mean flap weight of 330 g could be harvested from the medial thigh donor site in our patients, where the proportional excess of soft tissue can be significant compared to other parts of the body [ 20 ]. In this context Weichman et al investigated the impact of low BMI on the feasibility of performing autologous breast reconstruction with various flaps from the lower abdomen, bottom and thigh [ 19 ]. Similar to our study, the mean flap weight per breast used was 387 g in low–normal (18.5–22 kg/m 2 ) weight patients and 367 g in high–normal (22–25 kg/m 2 ) weight patients.…”

Safety and donor site morbidity of the transverse musculocutaneous gracilis (TMG) flap in autologous breast reconstruction—A systematic review and meta‐analysis

“…The deep inferior epigastric perforator (DIEP) flap derived from the abdomen is considered the first choice in autologous breast reconstruction with success rates of up to 99% 2,3 . However, patients with insufficient abdominal tissue or previous abdominal surgeries require alternative donor sites for tissue harvest 4 . Moreover, some patients might refuse the procedure to avoid the visible transverse donor site scar on the abdomen.…”

“…First outlined in 1992 by Yousif et al, 5,6 the TMG flap includes a horizontal skin island based on the transverse course of perforators arising from the gracilis muscle and the pliant soft tissue surplus from the medial thigh optimizing former limitations of the free gracilis musculocutaneous flap including flap volume and skin island vascularity. Due to excellent breast results with almost natural contour and shape, the TMG flap has gained popularity over the last few years 4,7,8 . Some authors even advertised the TMG flap as a first‐line option in slim to normal‐weight patients 7,9 .…”

Bilateral Simultaneous Breast Reconstruction with DIEP- and TMG Flaps: Head to Head Comparison, Risk and Complication Analysis

“…Various free flaps for autologous breast reconstructions are available and now represent routine procedures for breast reconstruction after skin-sparing or conventional mastectomy and breast conserving treatment. The deep inferior epigastric perforator (DIEP) flap became a gold standard [ 4 ] for breast reconstruction in patients with sufficient amounts of abdominal donor tissue [ 7 ]. In patients who do not offer enough abdominal donor tissue for reconstruction because of low body mass index or where the deep inferior epigastric vessels might have been damaged by prior abdominal surgeries, a vast number of alternative free flaps are available.…”