The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

A Silver Lining for Massive Weight Loss Patients with Breast Cancer: A Propensity-Matched Analysis Comparing Abdominal Outcomes after DIEP and Abdominoplasty

Authors: Amelia L. Davidson, MD, Jenna R. Stoehr, MD, William West, MD, Tim Nehila, BA, Nicole K. Le, MD, MPH, Kristen Whalen, MD, Abby Threet, MD, Deniz Dayicioglu, MD

Abstract

Objectives: Patients with a history of massive weight loss (MWL) frequently undergo body-contouring surgery such as abdominoplasty, and the safety profile of this procedure is well accepted. The deep inferior epigastric artery perforator (DIEP) flap is a procedure where excess abdominal tissue is used to reconstruct the breast. The abdominal muscles are preserved by isolating the flap on vascular perforators to the abdominal skin and adipose tissue, whereas in abdominoplasty, the same tissue is removed and discarded. In this study, the abdominal-contouring outcomes of patients who underwent DIEP breast reconstruction following MWL were compared with the abdominal contouring outcomes of those who received abdominoplasty following MWL.

Methods: A propensity-matched retrospective cohort study was performed comparing MWL patients who underwent either DIEP flap breast reconstruction after breast cancer treatments with mastectomy or abdominoplasty. Patients were matched for multiple preoperative variables. Statistical analysis included an independent-samples t test and the Fisher exact test for univariate analysis and multivariate analysis for predictive variables of postoperative complications.

Results: Eighteen patients with a history of MWL who underwent DIEP flaps were matched to 18 patients who underwent abdominoplasty. Patient data for the DIEP cohort were obtained from a database of 314 patients and a total of 484 flaps performed at our institution. Patient data for the abdominoplasty cohort were obtained from a database of 155 patients who underwent abdominoplasty at our institution. Groups differed on body mass index and total body weight loss (P = 0.008 and P = 0.002, respectively), but they did not differ in excess body weight loss (P = 0.094). All abdominoplasty patients and 50% of the DIEP patients had undergone bariatric surgery. Complication rates at the abdominal site were similar between the two groups (DIEP 33% vs body-contouring surgery 39%, P = 0.73).

Conclusions: Patients with DIEP procedures were found to have abdominal complication rates similar to those who received standard abdominoplasty. This information can be used by plastic surgeons to counsel MWL patients considering DIEP that their chance of a postoperative abdominal complication is similar to abdominal body-contouring procedures.
Posted in: Breast Cancer21

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References

1. American Society of Plastic Surgeons. Massive Weight Loss Fuels Surge In Plastic Surgery. https://www.plasticsurgery.org/news/press-releases/massive-weight-loss-fuels-surge-in-plastic-surgery. Published 2015. Accessed May 15, 2024.
 
2. Sinik L, Egan KG, Patel K, et al. A Systematic Review of Breast Reconstruction Options After Mastectomy in Massive Weight Loss Patients. Ann Plast Surg 2022;88:353–359. doi: 10.1097/SAP.0000000000002940.
 
3. Gusenoff JA, Coon D, De La Cruz C, et al. Superficial inferior epigastric vessels in the massive weight loss population: implications for breast reconstruction. Plast Reconstr Surg 2008;122:1621–1626. doi:10.1097/PRS.0b013e31818cbf80.
 
4. Shayan R, Rozen WM, Bernard S, et al. Perforator dilatation induced by body weight gain is not reversed by subsequent weight loss: implications for perforator flaps. Plast Reconstr Surg 2008;122:1765–1772. doi:10.1097/PRS.0b013e31818cc0ff.
 
5. Dayicioglu D, Tugertimur B, Munzenmaier K, et al. Outcomes of Breast Reconstruction After Mastectomy Using Deep Inferior Epigastric Perforator Flap After Massive Weight Loss. Ann Plast Surg 2016;76(Suppl 4):S286–S289. doi:10.1097/SAP. 0000000000000677.
 
6. Sinik LM, Elver AA, Egan KG, et al. Autologous Breast Reconstruction after Massive Weight Loss: Understanding Risks in a Growing Population. Plast Reconstr Surg 2023;152:503–512. doi:10.1097/PRS.0000000000010318.
 
7. Sanger C, David LR. Impact of significant weight loss on outcome of body-contouring surgery. Ann Plast Surg 2006;56:9–13. doi:10.1097/01.sap.0000186512.98072.07.
 
8. Constantine RS, Davis KE, Kenkel JM. The effect of massive weight loss status, amount of weight loss, and method of weight loss on body contouring outcomes. Aesthet Surg J 2014;34: 578–583. doi:10.1177/1090820X14528208.
 
9. Seth AK, Lin AM, Austen WG Jr, et al. Impact of Patient Subtype and Surgical Variables on Abdominoplasty Outcomes: A 12-Year Massachusetts General Hospital Experience. Plast Reconstr Surg 2017;140:899–908. doi:10.1097/PRS.0000000000003816.
 
10. Salgarello M, Tambasco D, Farallo E. DIEP flap donor site versus elective abdominoplasty short-term complication rates: a meta-analysis. Aesthetic Plast Surg 2012;36:363–369. doi:10. 1007/s00266-011-9804-y.
 
11. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187–196. doi:10.1097/SLA. 0b013e3181b13ca2.
 
12. Eltahir Y, Werners L, Dreise MM, et al. Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg 2013;132:201e–209e. doi:10.1097/PRS. 0b013e31829586a7.
 
13. Eltahir Y, Krabbe-Timmerman IS, Sadok N, et al. Outcome of Quality of Life for Women Undergoing Autologous versus Alloplastic Breast Reconstruction following Mastectomy: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2020;145:1109–1123. doi:10. 1097/PRS.0000000000006720.
 
14. Jones G, Yoo A, King V, et al. Prepectoral Immediate Direct-to-Implant Breast Reconstruction with Anterior AlloDerm Coverage. Plast Reconstr Surg 2017;140(6S Prepectoral Breast Reconstruction):31S–38S. doi:10.1097/PRS.0000000000004048.
 
15. Thuman J, Freitas AM, Schaeffer C, et al. Prepectoral Wise-Pattern Staged Implant-Based Breast Reconstruction for Obese or Ptotic Patients. Ann Plast Surg 2019;82(6S Suppl 5): S404–S409. doi:10.1097/SAP.0000000000001791.
 
16. Gabriel A, Storm-Dickerson TL, Chan V, et al. Prepectoral Breast Reconstruction in Morbidly Obese Patients. Plast Reconstr Surg Glob Open 2022;10:e4261. doi:10.1097/GOX. 0000000000004261.
 
17. Kamel GN, Mehta K, Nash D, et al. Patient-Reported Satisfaction and Quality of Life in Obese Patients: A Comparison between Microsurgical and Prosthetic Implant Recipients. Plast Reconstr Surg 2019;144:960e–966e. doi:10.1097/PRS.0000000000006201.
 
18. Arthurs ZM, Cuadrado D, Sohn V, et al. Post-bariatric panniculectomy: pre-panniculectomy body mass index impacts the complication profile. Am J Surg 2007;193:567–570. doi:10. 1016/j.amjsurg.2007.01.006.
 
19. Fahmy JN, Kong L, Benitez TM, et al. Postbariatric Panniculectomy: Postoperative Complications by Weight Loss Surgery Type. Plast Reconstr Surg 2025;155:354–361. doi:10. 1097/PRS.0000000000011365.
 
20. Marouf A, Mortada H. Complications of Body Contouring Surgery in Postbariatric Patients: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2021;45:2810–2820. doi:10. 1007/s00266-021-02315-2.
 
21. Rubin JP, Nguyen V, Schwentker A. Perioperative management of the post-gastric-bypass patient presenting for body contour surgery. Clin Plast Surg 2004;31:601–610, vi. doi:10. 1016/j.cps.2004.03.017.
 
22. Katzel EB, Shakir S, Kostereva N, et al. Abnormal Vessel Architecture Persists in the Microvasculature of the Massive Weight Loss Patient. Plast Reconstr Surg 2016;137: 24e–30e. doi:10.1097/PRS.0000000000001905.
 
23. Steven S, Carey PE, Small PK, et al. Reversal of type 2 diabetes after bariatric surgery is determined by the degree of achieved weight loss in both short- and long-duration diabetes. Diabet Med 2015;32:47–53. doi:10.1111/dme.12567.
 
24. American Society of Plastic Surgeons. Practice Parameter for Surgical Treatment of Skin Redundancy for Obese and Massive Weight Loss Patients. https://www.plasticsurgery.org/documents/Health-Policy/Guidelines/guideline-2017-skin-redundancy.pdf. Published 2017. Accessed May 19, 2025.
 
25. Wakefield W, Rubin JP, Gusenoff JA. The life after weight loss program: a paradigm for plastic surgery care after massive weight loss. Plast Surg Nurs 2014;34:4–10. doi:10.1097/ PSN.0000000000000021.
 
26. Kuc A, King K, Daggett J, et al. Direct Perforator Anastomosis of Free ALT Flap in Massive Weight Loss Due to Increased Size of Vessels. Eplasty 2017;17:ic14.
 
27. Dayicioglu D. Tissue transfer for cancer reconstruction in the massive weight loss patient. https://www.jaypeedigital.com/book/9781907816284/chapter/ch21; 2013.
 
28. Elander A, Biorserud C, Staalesen T, et al. Aspects of excess skin in obesity, after weight loss, after body contouring surgery and in a reference population. Surg Obes Relat Dis 2019;15: 305–311. doi:10.1016/j.soard.2018.10.032.
 
29. Elander A, Biorserud C, Fagevik Olsen M. Excess skin after weight loss following bariatric surgery: focus on the abdomen. Surg Obes Relat Dis 2021;17:986–993. doi:10.1016/j.soard. 2021.01.005.
 
30. Munhoz AM, Sturtz G, Montag E, et al. Clinical outcome of abdominal wall after DIEP flap harvesting and immediate application of abdominoplasty techniques. Plast Reconstr Surg 2005;116:1881–1893. doi:10.1097/01.prs.0000191186.20698.0d.